EPILEPSY SURGERY IN THE FIRST 3 YEARS OF LIFE

Purpose: Partial seizures in early postnatal life may be catastrophic and associated with poor long-term outcome. Epilepsy surgery can allev iate partial seizures in older children and adults, but there is littl e experience with surgical therapy in infancy apart from hemispheric e pilepsy syndromes. Methods: We analyzed the results of cortical resect ion to treat medically refractory partial epilepsy in 31 children (16 boys, 15 girls) aged <3 years (mean, 18.3 months). Subjects were inclu ded only if seizure relief was the primary indication for surgery. Res ults: Follow-up of at least 1 year (mean, 4.6 years) in 26 patients re vealed that 16 were seizure-free, 4 had >90% seizure reduction, and 6 had <90% reduction. There was no significant difference in seizure out come between hemispherectomy/multilobar resections and lobar resection s or temporal versus extratemporal resection. Seizure outcome was inde pendent of the amount of cortex removed in nonlesional patients. Only the presence of a discrete lesion on preoperative neuroimaging correla ted with a favorable outcome. Family perceptions of accelerated develo pment in seizure-free patients were not confirmed on developmental ass essment. Conclusions: We conclude that cortical resection often benefi ts very young children with catastrophic partial seizures, but does no t guarantee enhanced neurological development. The location and extent of the excised cortex may not be critical as long as the entire epile ptogenic region and lesion are removed.