Clinicopathological findings in patients who have undergone epilepsy surgery in the first year of life

Epilepsy presenting early in childhood may be associated with a neurologica lly devastating clinical course and have significant implications for the c hild's development. There are limited published data regarding the clinicop athological features of patients who have undergone epilepsy surgery in the first year of life and the role such surgery may have in reducing seizure frequency. This study retrospectively reviews the clinicopathologic feature s of eight patients from a tertiary care setting who underwent surgery for epilepsy in the first year of life. Eight infants, including seven males an d one female, underwent surgery for epilepsy at 3-11 months of age (median 7.5 months). Age at the time of seizure onset ranged from birth to 2 months . Epileptogenic foci were localized by electroencephalographic and radiogra phic studies to the right side in five patients and left side in three pati ents. Histopathological findings in excised tissues included cortical dyspl asia (n = 7), hemimegalencephaly (n = 3), and Sturge-Weber syndrome (n = 1) . Dysplasia was marked by abnormalities in cortical lamination and neuronal orientation (n = 7), neuronal cytomegaly (n = 6), increased molecular laye r neurons (n = 5) and balloon cells (n = 2). One patient was known to have epidermal nevus syndrome. Two patients required additional surgery for cont inued seizures. At last known follow up, all but one patient, who died in t he postoperative period, were alive with no or decreased seizures at postop erative intervals of 3-60 months (median 13 months). Surgery can potentiall y ameliorate epilepsy in patients less than 1 year of age. Most of the pati ents in this series had cortical dysplasia as the underlying pathology of t heir epilepsy.