Neurological

Early epilepsy surgery in infants with better seizure control

Epilepsy surgeries before the age of 3 months are associated with excellent seizure control and do not result in more permanent morbidity than surgeries in older infants, according to the results of the study published in Epilepsia.

Onset of epilepsy in the first few months of life is challenging, especially in infants with less common drug-resistant epilepsy (DRE) that requires surgery. “Ultra-early” epilepsy surgery is not common before 3 months of age, so literature and data on the effectiveness and safety of DRE surgery and its ability to control seizures are limited. Typically, epilepsy surgery is postponed until the child is older to minimize the risks in infants, but living with epilepsy as an infant can also come with its own seizure and medication risks. The aim of the current study was to review the safety and effectiveness of ultra-early epilepsy surgeries performed before the age of 3 months.

The multinational, retrospective study included data from 19 epilepsy centers of all children who had had epilepsy surgery before they were 3 months (or 100 days) after the 40th week of pregnancy from 1999 to 2020.

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A total of 64 infants (34 males) were included – 55 infants (86%) were full term and 9 (14%) were born prematurely. Participants’ ages at the onset of seizures ranged from 0 to 49 days (6.6 ± 11.8), and 4 babies (6%) were suspected of having seizures prior to birth.

The children had 69 surgeries before the age of 3 months and their age at the first surgery ranged from 14 to 113 days (72 ± 22). Procedures included 12 focal resections, 7 lobectomies, and 48 hemispherical surgeries, and no perioperative deaths occurred.

The median follow-up time was 41 months (interquartile range [IQR], 19-104) and 22 infants (34%) had additional epilepsy surgery. No significant correlation was observed between the type of surgery and the need for additional surgery (36% vs. 27% for hemispherical or focal resections, P = .42).

Regarding the results, 66% of the cases achieved an excellent epilepsy outcome (International League Against Epilepsy [ILAE] Grade I), 2% achieved ILAE II, 8% achieved ILAE III, 12% achieved ILAE IV and 12% achieved ILAE V. No significant correlation was found between ILAE grade and type of operation (P = 0.44).

Of the infants who did not require additional surgery, 85% were ILAE I-II versus 39% of the infants who required additional surgery (P = 0.0001).

At the last follow-up visit of 58 children for whom data were available, postoperative patients 0 to 6 (median 1, IQR 0.75-3) received anti-epileptic drugs vs. 1 to 11 (median 4, IQR 3-4) before surgery ( P <.0001), a median decrease of 2 drugs (IQR 1-3). Of this group, 79% had reduced their number of preoperative drugs by at least 1 drug.

In addition to the retrospective design of the study, the researchers found that they did not get any participants’ body weights at surgery, nor any data on electrolyte imbalances or fever. Outcome measurements were limited, the study did not include a control group, and data were collected from multiple centers and conducted by multiple surgeons.

“Excellent surgical technique, anesthesia and intensive care treatment are prerequisites for good results, and only centers with experience in complex operations on very young infants should treat such cases,” advise the researchers. “We therefore recommend that you do not delay the surgical treatment of the very young because of their age.”

reference

Roth, J., Constantini, S., Ekstein, M., et al. Epilepsy Surgery in Infants Up to 3 Months: Safety, Feasibility, and Results: A Multicenter, Multinational Study. Epilepsy. Published online June 14, 2021. doi: 10.1111 / epi.16959

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