Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy

Kumar, Ramesh; Koh, Susan; Knupp, Kelly G.; Handler, Michael H.; O’Neill, Brent R

doi:10.1007/s00381-015-2759-6

Cited by 40 publications

(49 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results for early infancy (new born to 3 months) are comparable to the previous series on epilepsy surgery during infancy (most operated between 3 months to 3 years). Our epilepsy outcome of about 60%–70% ILAE grade I (at a median follow‐up of about 3.5 years) is essentially comparable to the previous series focusing on hemispherotomy and focal surgery in infancy 12,25,26,28,30,39,41 . A 34% rate for additional surgeries (irrespective to the type of surgery) may be related to the etiology (mostly developmental causes), which are notorious for higher failure rates compared to acquired and progressive etiologies 48 .…”

Section: Discussionsupporting

confidence: 82%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 82%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In contrast to the typical etiologies of DRE in older children and adults, the etiologies of DRE predominating in very young children included hemispheric syndromes such as Sturge-Weber syndrome (SWS), Rasmussen encephalitis, and hemimegalencephaly; malformations of cortical development (MCD) such as focal cortical dysplasia (FCD), polymicrogyria, and heterotopias; vascular malformations or stroke; tuberous sclerosis complex (TSC); neoplasms such as ganglioglioma, dysembryoplastic neuroepithelial tumor (DNET), other low-grade tumors, and malignant tumors; gliosis; and prior infection such as encephalitis (Table 1). 30,35,40,44,45,50,51,69,70,73 Prevalence estimates of each etiology generally agreed with those reported by Harvey et al in children younger than 4 years with DRE in an international survey of epilepsy procedures. 34 Overall, only approximately 1% of infants and toddlers with DRE (4 of 444) harbored hippocampal sclerosis.…”

Section: Summary Of Literature Reviewsupporting

confidence: 87%

Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy

Pindrik

Hoang

Smith

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEDespite perioperative risks, epilepsy surgery represents a legitimate curative or palliative treatment approach for children with drug-resistant epilepsy (DRE). Several factors characterizing infants and toddlers with DRE create unique challenges regarding optimal evaluation and management. Epilepsy surgery within children < 3 years of age has received moderate attention in the literature, including mainly case series and retrospective studies. This article presents a systematic literature review and explores multidisciplinary considerations for the preoperative evaluation and surgical management of infants and toddlers with DRE.METHODSThe study team conducted a systematic literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, targeting studies that investigated children < 3 years of age undergoing surgical treatment of DRE. Using the PubMed database, investigators selected peer-reviewed articles that reported seizure outcomes with or without developmental outcomes and/or perioperative complications. Studies were eliminated based on the following exclusion criteria: sample size < 5 patients; and inclusion of patients > 3 years of age, when demographic and outcomes data could not be separated from the cohort of patients < 3 years of age.RESULTSThe study team identified 20 studies published between January 1990 and May 2017 that satisfied eligibility criteria. All selected studies represented retrospective reviews, observational studies, and uncontrolled case series. The compiled group of studies incorporated 465 patients who underwent resective or disconnective surgery (18 studies, 444 patients) or vagus nerve stimulator insertion (2 studies, 21 patients). Patient age at surgery ranged between 28 days and 36 months, with a mean of 16.8 months (1.4 years).DISCUSSIONThe study team provided a detailed summary of the literature review, focusing on the etiologies, preoperative evaluation, surgical treatments, seizure and developmental outcomes, and potential for functional recovery of infants and toddlers with DRE. Additionally, the authors discussed special considerations in this vulnerable age group from the perspective of multiple disciplines.CONCLUSIONSWhile presenting notable challenges, pediatric epilepsy surgery within infants and toddlers (children < 3 years of age) offers significant opportunities for improved seizure frequency, neuro-cognitive development, and quality of life. Successful evaluation and treatment of young children with DRE requires special consideration of multiple aspects related to neurological and physiological immaturity and surgical morbidity.

show abstract

“…42 In other studies, rates increased in surgical series of infancy from zero to 47%. 32,43,44 Neurological complications of epilepsy surgery decreased substantially. However, implantation of intracranial electrodes increased the frequency of adverse events due to increased number of staged operations performed in children.…”

Section: Safety Issuementioning

confidence: 99%

“…Early surgical intervention was shown to be effective in ameliorating seizures in 46% to 80% of children operated before the age of three in 1996-2015, with similar outcomes in older children. 32 However, the reported risks of brain surgery were the highest in the younger age group. On the other hand, brain plasticity and potential recovery are significantly higher during early life, especially in the first year of age.…”

mentioning

confidence: 99%

Recent Aspects of Pediatric Epilepsy Surgery

Kwon¹,

Kim²

2020

J Epilepsy Res

View full text Add to dashboard Cite

Surgery has been and is now a well-established treatment indicated for adults and children with drug-resistant epilepsy (DRE). The surgical landscape for children with DRE appears to be expanding, and surgical cases of pediatric epilepsy have increased significantly in the past decade, contrary to adult epilepsy. Several fundamental changes have led to the widespread surgical treatment for DRE in children, based on a risk-benefit analysis of pediatric epilepsy surgery, and a change in our overall approach to evaluation. There are unique and age-related differences associated with pediatric epilepsy surgery, characterized by different types of etiologies, concerns for developmental progress, and safety issues. Indications for "pediatric epilepsy surgery" have been broadened to include a wide spectrum of etiologies without excluding children with "generalized" seizures, "generalized or multifocal eletroencephlography", or patients with contra-lateral epileptiform activity or magnetic resonance imaging abnormalities. Furthermore, epilepsy surgery is increasingly considered in infancy and early childhood, which has similar surgical outcomes as the case of late childhood, in an effort to improve the eventual development outcome. Seizure freedom, or at least seizure reduction, is an excellent result with resolution of the associated epileptic encephalopathy, normalization of the EEG, and decrease in the total epileptic burden in the pediatric field.

show abstract

Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy

Cited by 40 publications

References 41 publications

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

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

Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy

Recent Aspects of Pediatric Epilepsy Surgery

Contact Info

Product

Resources

About