Epilepsy Surgery in the First 3 Years of Life: Predictors of Seizure Freedom and Cognitive Development

Navah Ester Kadish, Thomas Bast, Gitta Reuner, Kathrin Wagner, Hans Mayer, Susanne Schubert-Bast, Gert Wiegand, Karl Strobl, Armin Brandt, Rudolf Korinthenberg, Vera van Velthoven, Andreas Schulze-Bonhage, Josef Zentner, Georgia Ramantani

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22 Citations (Scopus)

Abstract

BACKGROUND Although the majority of children undergoing epilepsy surgery are younger than 3 yr at epilepsy manifestation, only few actually receive surgical treatment in early childhood. Past studies have, however, suggested that earlier intervention may correlate with superior developmental outcomes.

OBJECTIVE To identify predictors for long-term seizure freedom and cognitive development following epilepsy surgery in the first 3 yr of life and determine the appropriate timing for surgical treatment in this age group.

METHODS We retrospectively analyzed the data of 48 consecutive children aged 1.10.7 yr at surgery.

RESULTS Final surgeries comprised 52% hemispherotomies, 13% multilobar, and 35% intralobar resections. Etiology included cortical malformations in 71%, peri- or postnatal ischemic lesions in 13%, and benign tumor or tuberous sclerosis in 8% each. At last follow-up (median 4.3, range 1-14.3 yr), 60% of children remained seizure-free: 38% had discontinued antiepileptic drugs. Intralobar lesionectomy resulted more often in seizure control than multilobar or hemispheric surgery. Postsurgical seizure freedom was determined by the completeness of resection. Early postsurgical seizures were key markers of seizure recurrence. Presurgical adaptive and cognitive developmental status was impaired in 89% children. Longer epilepsy duration and larger lesion extent were detrimental to presurgical development, which, in turn, determined the postsurgical developmental outcome.

CONCLUSION Our study demonstrates that epilepsy surgery in very young children is safe as well as efficient regarding long-term seizure freedom and antiepileptic drug cessation in selected candidates. Longer epilepsy duration is the only modifiable predictor of impaired adaptive and cognitive development, thus supporting early surgical intervention.
Original languageEnglish
Pages (from-to)E368-E377
Number of pages10
JournalNeurosurgery
Volume84
Issue number6
DOIs
Publication statusPublished - Jun 2019

Keywords

  • Refractory epilepsy
  • Developmental
  • Children
  • Focal cortical dysplasia
  • Hemispherotomy
  • Multilobectomy

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