Abstracts

Rationale: In the USA, half a million children under age 17 suffer from epilepsy and 20-30% of them progress to drug-resistant epilepsy (DRE) (CDC, 2022). Patients with epilepsy due to structural causes tend to present early in life and are often intractable to anti-seizure medications (ASMs). They should undergo early referral and evaluation for epilepsy surgery. Epilepsy surgery in the first 3 years of life is safe and effective (Dwivedi, 2017) and has been shown to improve neurodevelopmental outcomes (Yu, 2023). However, a paucity of published data exists regarding early-life epilepsy surgery outcomes. We report our institutional experience of epilepsy surgery under 2 years.

Methods: A single-site retrospective chart review of patients younger than 2 years who underwent epilepsy surgery between 2018 and 2024. Data was accessed using a local REDCAP surgery database. Parameters included patient demographics, etiology, epilepsy type, number of failed ASMs, age at surgery, type of surgery, pathology if available, repeat surgeries if any, medications weaned and duration of follow up in months. Post surgical clinical outcomes were denoted by Engel criteria for sake of consistency.

Results: 10 patients < 2 years were identified. 6/10 (60%) were female and 4/10 (40%) were male. The median age at time of surgery was 0.7 years (range 0.2-1.6 years). The most common etiology was cortical malformations and the median number of failed ASMs at time of surgery was 4. The surgeries included 5 resections, 5 disconnections, 2 ablations. 2/10 patients had a second surgery. There were no significant surgical complications in our cohort. The follow up duration was 6 months to 6 years. One patient was lost to follow up after 3 years. The most updated surgical outcomes were documented as follows: 7/10 (70%) were Engel class 1a, 2/10 (20%) were Engel class 3a, and 1 was class 3b. Successful medication wean of at least 1 ASM was achieved in 8/10 (80%) patients. Caregiver reported developmental outcomes indicated improvement and catch up of milestones.

Conclusions: Our study verifies that epilepsy surgery in patients under 2 years is both effective and safe with improved seizure outcomes. Most patients had cortical malformations and were deemed intractable to ASM at the time of surgery. There were no significant complications of surgery and prolonged follow up showed sustained seizure freedom and developmental catch up. These results emphasize the importance of early referral to a pediatric epilepsy surgery center and the need for appropriate long term follow up. Larger multicenter studies with a focus on minimizing referral delays are needed.

Funding: None