Introduction: Infants with epilepsy often have a catastrophic course. There is a historical reluctance to operate in the very young, though experience is accumulating that persistent early seizures are detrimental.
Methods: Epilepsy operations performed on children under one year of age between 2002 and 2013 were reviewed for demographic information, seizure outcome, and surgical complications.
Results: 25 patients were 18 days to 11 months at operation, the mean age 141 days, and median 99 days. 17(68%) of these had seizures by the first two weeks of life. All had daily seizures and 80% had more than 10 seizures per day. 22 had an abnormal MRI.
15(60%) patients underwent hemispherotomy at initial operation, and one an anatomical hemispherectomy. Seven(32%) infants had grid placement followed by focal resection. One of these required a subsequent hemispherotomy. One patient underwent a frontal lobe resection with electrocorticography but required a subsequent grid placement with repeat resection. One had resection of a temporal DIGG. All underwent blood transfusions, but had no other complications. Two hemispherectomies were aborted because of bleeding, and completed at a subsequent operation.
Focal cortical dysplasia was the most common pathology (10 patients,45%) followed by hemimegalencephaly (7 patients,32%). One patient each had hemispheric infarct, Tuberous sclerosis, Sturge-Weber, atypical Rhett syndrome, and cobolamine C deficiency.
Mean follow-up was 53 months. 21 patients(84%) are seizure free, 10(40%) on no anticonvulsant. One patient is Engle class 2, and the remaining 3 patients were Engel class 4, one of whom died with status epilepticus from the contralateral hemisphere. Shunts were required in 5(20%).
Conclusions: This large single-institution experience supports that infants with localization-related catastrophic epilepsy can have safe operations and excellent outcomes. There is no reason to delay intervention until they are older and have a longer-standing seizure burden.
Patient Care: This research illustrates the effectiveness of epilepsy surgery in children under a year of age as well as alerts treating physicians to the potential risks and complications associated with surgery in this young patient population.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the efficacy of epilepsy surgery in children under one year of age, 2)identify the risks and complications associated with surgery in this age group and, 3)understand the potential pitfalls one may encounter in the diagnosis and treatment of these patients.