Epilepsy surgery in infants up to 3 months of age: Safety, feasibility, and outcomes: A multicenter, multinational study

Abstract

Summary Objective Drug‐resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on “ultra‐early” epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study's goal is to review the safety and efficacy of ultra‐early epilepsy surgery performed before the age of 3 months. Methods To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications. Results Sixty‐four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty‐five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow‐up of 41 months (19–104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1–3 IQR, p < .0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections). Significance Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.

Epilepsy surgery in the first six months of life: A systematic review and meta-analysis

“…Of the remaining 214 studies the full text was assessed for the inclusion criteria mentioned above. Only 14 were included [27][28][29][30][31][32][33][34][35][36][37][38][39][40]. In addition, two more articles were discovered by assessing the references of the reviewed articles [41,42].…”

“…In addition, two more articles were discovered by assessing the references of the reviewed articles [41,42]. In total, four studies strictly reported on outcomes after epilepsy surgery in infants below the age of six months [27,29,32,33]. All studies were retrospective.…”

“…Only 17 infants (10.8%) did not show a successful outcome. Roth et al described eight patients with ILAE V outcome without further information (6% focal surgery, 14% hemispheric surgery) [27]. Altogether, Kudr et [30,31].…”

Case Report: Hemispherotomy in the First Days of Life to Treat Drug-Resistant Lesional Epilepsy

“…Putative and largely unknown complications of an early intervention should be weighed against the risk of life-long developmental drawbacks of ongoing detrimental epilepsy and/or anticonvulsant therapy. However, early epilepsy surgery in infancy is receiving increased attention (10,11). First results are promising with seizure freedom ranging from 66 to 82.7%.…”

Longitudinal neurological analysis of moderate and severe pediatric cerebral visual impairment

“…Additionally, the use of multiple antiseizure medications was also negatively associated with longitudinal CVI outcome, and suggests that Practically, it is important for the vision care provider to consider the number of seizure medications and whether if it may be affecting the child's performance during a CVI vision assessment. This would importantly pair up with the increasing tendency toward early aggressive seizure/epilepsy management among neurologists, including offering earlier curative or palliative epilepsy surgery options and few medication trials (Prideaux et al, 2018;Roth et al, 2021;Perry et al, 2022).…”