title: Surgical versus medical treatment for children with epileptic encephalopathy in infancy and early childhood: Results of an international multicenter cohort study in Far-East Asia (the FACE study).
abstract: OBJECTIVE
  To compare the seizure and developmental outcomes in infants and young children with epileptic encephalopathy who have undergone surgical and medical treatments.
  
  
  METHODS
  An international, multicenter, observational cohort study was undertaken. A total of 317 children aged <6 years, who had frequent disabling seizures despite intensive medical treatments, were registered. Among the enrolled children, 250 were treated medically (medical group), 31 underwent resective surgery (resective group), and 36 underwent palliative surgery [callosotomy (n=30) or vagal nerve stimulation (n=6); palliative group] on admission. Seizure and developmental outcomes were obtained for 230 children during the 3-year follow-up period. Cox proportional hazard model was used to adjust for clinical backgrounds among treatment groups when comparing the seizure-free survival rates.
  
  
  RESULTS
  At the 3-year follow-up, seizure-free survival was 15.7%, 32.1%, and 52.4% in the medical, palliative, and resective groups, respectively. The adjusted hazard ratios for seizure recurrence in the resective and palliative groups versus the medical group were 0.43 (95% CI, 0.21-0.87, P=0.019) and 0.82 (95% CI, 0.46-1.46, P=0.50), respectively; the former was statistically significant. Regarding the developmental outcome, the mean DQs in the resective group increased significantly compared to those in the medical group during the follow-up (P<0.01). As for subgroup analysis, better seizure and development outcomes were demonstrated in the resective group compared to the medical group in children with nonsyndromic epilepsies (those to which no known epilepsy syndromes were applicable).
  
  
  CONCLUSIONS
  These results suggest that surgical treatments, particularly resective surgeries, are associated with better seizure and developmental outcomes compared with successive medical treatment. The present observations may facilitate the identification of infants and young children with epileptic encephalopathy who could benefit from surgery.
authors.affiliation: Epilepsy Center, National Center of Neurology and Psychiatry, Tokyo, Japan. Electronic address: otsukit@ncnp.go.jp.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Otsuki
authors.affiliation: Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Heung-Dong
authors.initials: HD
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China.
authors.forename: Guoming
authors.initials: G
authors.lastname: Luan
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, National Nagasaki Medical Center, Nagasaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Baba
authors.affiliation: Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Oguni
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
authors.forename: Seung-Chyul
authors.initials: SC
authors.lastname: Hong
authors.affiliation: Department of Neurosurgery, Nishi-Niigata Chuo National Hospital, Niigata, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kameyama
authors.affiliation: Department of Child Neurology, Okayama University Hospital, Okayama, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hirose
authors.affiliation: Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Division of Neurology, Saitama Children's Medical Center, Saitama, Japan.
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Hamano
authors.affiliation: Epilepsy Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugai
mesh_terms: D001208:Asia; D001921:Brain / Q000601:surgery; D001927:Brain Diseases / Q000601:surgery / Q000628:therapy; D002675:Child, Preschool; D015331:Cohort Studies; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures; D012640:Seizures / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Developmental quotient; Epilepsy surgery; Epileptic encephalopathy; Prospective cohort study; Seizure outcome