SURGERY FOR CATASTROPHIC LOCALIZATION-RELATED EPILEPSY IN INFANTS

Cortical resection or hemispherectomy has been reported to result in c essation or dramatic reduction of seizures for small numbers of highly selected infants with severe, intractable epilepsy and developmental delay. However, identification of potential surgical candidates during infancy can be especially challenging because seizure semiology and E EG may sometimes give limited localizing information, e.g., in patient s with infantile spasms and hypsarrythmia due to focal cortical dyspla sia or a tumor. In infants as well as older patients, the location of a potentially resectable epileptogenic lesion must be defined by conve rgence of results from video EEG, anatomic and functional neuroimaging , and clinical examination. Reported outcomes after surgery in small s eries include 78% of 23 infants seizure-free or with at least 90% seiz ure reduction (1993 University of California at Los Angeles series), a nd 75% of 12 infants seizure-free or with rare seizures (1995 Clevelan d Clinic series). A tendency of ''catch-up'' developmental progress af ter surgery was observed in both series. A few reports of smaller grou ps of infants noted similar results. Prospective studies are in progre ss to better define the potential risks and benefits of early surgical intervention for infants and catastrophic localization-related epilep sy.