Abstracts

Partial seizures in early childhood may be catastrophic and associated with poor long-term outcome. Epilepsy surgery is an established form of treatment for older children and adults, but there are few large published studies reporting the outcome of epilepsy surgery in very early life.
We analyzed the results of excisional surgery for partial epilepsy in 75 patients under age 3 years(mean ,16 months) Age of seizure onset ranged from the first day of life to 22 months(mean 4.6 months). Subjects were included only if the primary indication for surgery was seizure relief. 3 children had 2 surgeries.
Twenty (27%) out of 75 children underwent hemispherectomies, 24 (32%) had multilobar and 31 (41%) had lobar resections. Pathologies included cortical dysplasia (n=37), tuberous sclerosis (n=9), vascular malformations (n=4), developmental brain tumors (n=14), encelphalomalacic lesions (n=10), and hippocampal sclerosis (n=1). At mean follow-up of 7 years (range 1 to 24 years), 40 (53%) are seizure free, 9 (12%) have [gt] 90% reduction, 9 (12%) have [gt] 50% reduction and 12(16%) are unchanged. Outcome did not differ significantly with extent of resection. However, seizure freedom occurred in 16(43%) of patients with cortical dyplasia , 4 (44%) with tuberous sclerosis, 2 (50%) with vascular malformations,11(80%) developmental tumors, 5 (50%) with encephalomalacic lesions.
Our results further confirm the efficacy of excisional procedures to treat catastrophic seizures in very young patients. Seizure outcome is independent of surgical location and extent of resection. Patients with developmental tumors have better outcomes than patients with cortical dysplasia.