gms | German Medical Science

Objective: Resective surgery in children is an established method to treat drug-resistant epilepsy. Our goal was to determine risk and benefit of this invasive treatment option in very young children.

Method: We retrospectively analyzed data of 49 children who underwent surgery up to the age of 72 months. We excluded disconnective procedures (hemispherotomy, callosotomy). Long-term follow-up (FU) was assessed either by clinical records or routine FU telephone interviews.

Results: Mean age at seizure onset was 19 months. Noninvasive EEG showed focal epileptic discharges (69%), both generalized and focal ETPs (19%) and only generalized ETPs (12%). Invasive EEG recording was done in 10%. Preoperative MRI suspected mostly dysplasias. Mean age at surgery was 45 months. Localization was extratemporal in 41.2%, temporo-mesial in 27.5%, multilobar in 21.6 and temporal but not mesial in 9.8%. Most common histological findings were dysplasias (54%), tumors (36%) and hippocampal-sclerosis (6%). Tumors were graded WHO°I except one ganglioglioma WHO°II. Three patients had a new permanent deficit: One patient with occipital lesion suffered from hemianopia as calculated deficit; one patient had a hemiparesis, one a hemianopia where a quadrantanopia was expected (permanent unexpected morbidity 4.1%). There was no mortality. After a mean FU of 7.7 years (range 1–23yrs) 73.5% were completely seizure free at last FU (ILAE 1) and 30.2% of these were without antiepileptic drugs. 12% showed marked improvement (ILAE 2–4). A circumscribed lesion in preoperative MRI shows a tendency towards better epilepsy-control. Presurgical generalized EEG was not associated with a worse outcome. There were no other significant correlations between potentially predictive factors (age at onset, age at surgery, duration of seizures, histology) and seizure outcome.

Conclusions: Despite the higher level of uncertainty in pre-surgical work-up and presumably higher rate of peri-operative complications, epilepsy-surgery in very young children is a safe and effective treatment option that renders approximately 3/4 of patients seizure free.