Developmental outcomes in children receiving resection surgery for medically intractable infantile spasms

Abstract

Two‐year postsurgical developmental outcomes were assessed in 24 children with infantile spasms who underwent resective surgery. The mean age of onset of infantile spasms was 12.0 weeks and the mean age at surgery was 20.8 months. Developmental outcomes were assessed using the Vineland Adaptive Behavior Scales (VABS). There was a significant increase in developmental level at 2 years postsurgery compared with presurgical levels. At 2 years postsurgery only one of the children in this series was severely retarded. The developmental outcomes of patients in the series were better than those in prior studies of symptomatic patients receiving medical treatment for infantile spasms. It is surprising that the children in the UCLA series frequently had developmental outcomes equal to and sometimes superior to other groups of children with infantile spasms, since all the UCLA patients were symptomatic, had neurologic deficits and had failed to respond to adrenocorticotropic hormone (ACTH) and antiepileptic drugs. The 2‐year postsurgery developmental outcomes were best for the children who received surgery, when they were relatively young and who had the highest level of developmental attainments presurgically.

Longer duration of epilepsy and earlier age at epilepsy onset correlate with impaired cognitive development in infancy

“…Our results indicate that the presence of infantile spasms at presentation should urge prompt medical and perhaps surgical intervention. To this effect, Asarnow et al [4] demonstrated that the 2-year postsurgical developmental outcomes of infants were best for the infants who underwent surgery when they were relatively young and who had the highest level of developmental performance presurgically, again supporting the idea that earlier intervention may halt epileptogenesis-related developmental deterioration.…”

“…Few available reports have evaluated the intellectual outcome in infants who have undergone epilepsy surgery [4], [11], [13] and [14]. According to results presented by Daniel et al, neuropsychological performance after surgery was best for children who underwent surgery at a younger age.…”

“…Others have shown that control of infantile spasms is associated with better development during infancy and childhood [4], [6], [10], [12], [22], [23], [24] and [25]. In a previous report [11], more frequent spasms in children undergoing early surgical intervention were documented.…”

“…The limited evidence that does exist in this age group is derived from longitudinal studies assessing postinterventional neuropsychological outcome in infants with West syndrome [4], [5], [6], [7], [8], [9], [10], [11], [12] and [13] and other epilepsies [5], [6], [7], [10], [11] and [14] (Table 1). Most of these studies have suggested that earlier surgical or medical therapy during infancy may provide higher benefit for intellectual development of children.…”

“…Most of these studies have suggested that earlier surgical or medical therapy during infancy may provide higher benefit for intellectual development of children. Seizure freedom may be associated with better mental development [4], [10], [11], [12], [13] and [14]. However, none of these studies have evaluated the effect of epilepsy in terms of duration and seizure burden on cognition during infancy.…”