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

Makridis, Konstantin L.; Atalay, Deniz A.; Thomale, Ulrich‐Wilhelm; Tietze, Anna; Elger, Christian E.; Kaindl, Angela M.

doi:10.1016/j.seizure.2022.02.009

Cited by 15 publications

(32 citation statements)

References 71 publications

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“…[11][12][13] We recently reported a seizure freedom rate of 66% after epilepsy surgery in the first 6 months of life in a metaanalysis including 158 patients matching the rates reported in older children and adults. 8 In this study, 57% of the children were seizure-free after a first epilepsy surgery. Most patients in the study had focal motor seizures, while few had epileptic spasms.…”

Section: Discussionmentioning

confidence: 64%

“…[17][18][19] In line with previous research, all infants in the present study had belowaverage DQ values before surgery. 8 DQ values declined but raw scores increased, indicating that these patients individually develop, but at a slower rate than average. This further strengthens the evidence that raw scores must be evaluated in patients after epilepsy surgery to assess individual development.…”

Section: Discussionmentioning

confidence: 92%

“…7 Thus, surgery in early infancy is seldomly performed, resulting in a lack of data on the specifics of the procedures and their outcomes. 8 Especially comprehensive data on complication rates and cognitive development in this specific age group are lacking. Our retrospective multicenter study aims to show real-world data on complications and outcomes of epilepsy surgery in the first 6 months of life.…”

Section: Introductionmentioning

confidence: 99%

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Epilepsy surgery in early infancy: A retrospective, multicenter study

et al. 2023

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Although epilepsy surgery is the only curative therapeutic approach for lesional drug‐resistant epilepsy (DRE), there is reluctance to operate on infants due to a fear of complications. A recent meta‐analysis showed that epilepsy surgery in the first 6 months of life can achieve seizure control in about two thirds of children. However, robust data on surgical complications and postoperative cognitive development are lacking. We performed a retrospective multicenter study of infants who underwent epilepsy surgery in the first 6 months of life. 15 infants underwent epilepsy surgery at a median age of 134 days (IQR: 58) at four centers. The most common cause was malformation of cortical development, and 13 patients underwent a hemispherotomy. Two thirds required intraoperative red blood transfusions. Severe intraoperative complications occurred in two patients including death in one infant due to cardiovascular insufficiency. At a median follow‐up of 1.5 years (IQR: 1.8), 57% of patients were seizure‐free. Three patients where reoperated at a later age, resulting in 79% seizure freedom. Anti‐seizure medication could be reduced in two thirds, and all patients improved in their development. Our findings suggest that early epilepsy surgery can result in good seizure control and developmental improvement. However, given the perioperative risks, it should be performed only in specialized centers.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Epilepsy surgery in early infancy: A retrospective, multicenter study

et al. 2023

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“…In these patients, the chance of reaching seizure freedom is lower than 15% ( 3 ). Given the increased risk of earlier death, poorer cognitive development, and reduced quality of life of patients with drug resistant epilepsy (DRE), ( 4 , 5 ) the possibility of a curative approach through epilepsy surgery must be assessed early ( 6 , 7 ). However, even in individuals with focal-onset DRE, epilepsy surgery is not always feasible as a curative (or palliative) approach.…”

Section: Introductionmentioning

confidence: 99%

Real-World Experience Treating Pediatric Epilepsy Patients With Cenobamate

et al. 2022

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IntroductionIn one third of all patients with epilepsy, seizure freedom is not achieved through anti-seizure medication (ASM). These patients have an increased risk of earlier death, poorer cognitive development, and reduced quality of life. Cenobamate (CNB) has recently been approved as a promising novel ASM drug for the treatment of adults with focal-onset epilepsy. However, there is little experience for its application in pediatric patients.MethodsIn a multicenter study we evaluated retrospectively the outcome of 16 pediatric patients treated “off label” with CNB.ResultsIn 16 patients with a mean age of 15.38 years, CNB was started at an age of 15.05 years due to DRE. Prior to initiation of therapy, an average of 10.56 (range 3–20) ASM were prescribed. At initiation, patients were taking 2.63 (range 1–4) ASM. CNB was increased by 0.47 ± 0.27mg/kg/d every 2 weeks with a mean maximum dosage of 3.1 mg/kg/d (range 0.89–7) and total daily dose of 182.81 mg (range 50–400 mg). Seizure freedom was achieved in 31.3% and a significant seizure reduction of >50% in 37.5%. Adverse events occurred in 10 patients with fatigue/somnolence as the most common. CNB is taken with high adherence in all but three patients with a median follow-up of 168.5 daysConclusionCenobamate is an effective ASM for pediatric patients suffering from drug-resistant epilepsy. In addition to excellent seizure reduction or freedom, it is well-tolerated. Cenobamate should be considered as a novel treatment for DRE in pediatric patients.

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“…Besides high risks of cognitive and psychosocial impairments in children with DRE with longer epilepsy duration, these results underline the necessity of epilepsy surgery evaluation as soon as possible. 2,[12][13][14] Presurgical seizure frequency did not significantly influence the postsurgical decrease of FB. However, with a seizure freedom rate of 87.1%, we only have a few patients with continuous seizure activity after surgery.…”

Section: Discussionmentioning

confidence: 78%

Family Burden and Epilepsy Surgery in Children with Drug-Resistant Epilepsy

et al. 2023

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Introduction Family burden (FB) in pediatric patients with drug-resistant epilepsy (DRE) is significantly higher than that in children with non-DRE. Epilepsy surgery is an established approach to treat DRE, and this study examines the impact of pediatric epilepsy surgery on FB. Methods We retrospectively analyzed data of families and pediatric patients with focal structural DRE treated with epilepsy surgery at our epilepsy center from April 2018 to November 2021. We examined the relationship between cognitive, behavioral, and epilepsy-specific data and the FB measured with the German version of the Impact on Family Scale before and after epilepsy surgery. Results The study cohort included 31 children with DRE at a mean age of 9 years at surgery (range = 0–16) and a mean epilepsy duration of 3 years (range = 0–14). Cognitive impairment correlated with FB in children with DRE prior to surgery. At the last assessment, 14.5 months (mean, range = 6–24) after epilepsy surgery, 87.2% of patients were seizure-free, FB values had decreased by 75.0%, and behavioral problems had decreased by 85,7%. Cognitive functions remained stable following epilepsy surgery. Conclusion In children with DRE, epilepsy surgery reduces FB. Given the considerable impact of families on the development and wellbeing of their children, the impact of epilepsy surgery should be communicated to affected families.

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

Cited by 15 publications

References 71 publications

Epilepsy surgery in early infancy: A retrospective, multicenter study

Epilepsy surgery in early infancy: A retrospective, multicenter study

Real-World Experience Treating Pediatric Epilepsy Patients With Cenobamate

Family Burden and Epilepsy Surgery in Children with Drug-Resistant Epilepsy

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