Surgery during early life in children with intractable epilepsy – A prospective evaluation

Purpose: Early-onset symptomatic focal epilepsy often is a drug-resistant, catastrophic disorder with a high frequency of seizures and subsequent developmental decline. Early surgery is an excellent therapeutic option for some of these patients.

Methods: We included 24 children (10 girls and 14 boys) less than age of 5 years at the time of presurgical evaluation. The median age at seizure onset was 1.0 year (range: first days of life to 3.5 years), the median age at the time of surgery was 3.5 years (range: 0.5 to 5.0 years). Duration of epilepsy showed a range of 0.5 to 4.0 years (median 1.5 years). All patients had a high preoperative seizure frequency ranging from 4 to 11 seizures/year up to more than 10 seizures per day (median: more than 10 seizures per day). We analysed seizure outcome and postoperative development as well as the prognostic relevance of the presurgical clinical and EEG data, the technique of surgery and histopathology.

Results: One year after surgery 77.3% of the patients were seizure-free. After 2 years in the group of 11 patients 90.9% had no seizures, 3 years postoperatively 3 of 4 patients were free of seizures, after 4 to 7 years postoperatively one of 2 patients had no seizures. One patient has been free of seizures 8 years after surgery. The majority of our patients showed a significant progress in their development (most impressing in the group of patients with Infantile Spasms).

Discussion: Early surgical intervention in this group of patients can interrupt a catastrophic progress and prevent developmental stagnation or even decline. We strongly recommend an early surgical evaluation of these patients.