• Navah Ester Kadish, Thomas Bast, Gitta Reuner, Kathrin Wagner, Hans Mayer, Susanne Schubert-Bast, Gert Wiegand, Karl Strobl, Armin Brandt, Rudolf Korinthenberg, Vera van Velthoven, Andreas Schulze-Bonhage, Josef Zentner, and Georgia Ramantani.
• Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany.
• Neurosurgery. 2019 Jun 1; 84 (6): E368-E377.

BackgroundAlthough the majority of children undergoing epilepsy surgery are younger than 3 yr at epilepsy manifestation, only few actually receive surgical treatment in early childhood. Past studies have, however, suggested that earlier intervention may correlate with superior developmental outcomes.ObjectiveTo identify predictors for long-term seizure freedom and cognitive development following epilepsy surgery in the first 3 yr of life and determine the appropriate timing for surgical treatment in this age group.MethodsWe retrospectively analyzed the data of 48 consecutive children aged 1.1 ± 0.7 yr at surgery.ResultsFinal surgeries comprised 52% hemispherotomies, 13% multilobar, and 35% intralobar resections. Etiology included cortical malformations in 71%, peri- or postnatal ischemic lesions in 13%, and benign tumor or tuberous sclerosis in 8% each. At last follow-up (median 4.3, range 1-14.3 yr), 60% of children remained seizure-free: 38% had discontinued antiepileptic drugs. Intralobar lesionectomy resulted more often in seizure control than multilobar or hemispheric surgery. Postsurgical seizure freedom was determined by the completeness of resection. Early postsurgical seizures were key markers of seizure recurrence. Presurgical adaptive and cognitive developmental status was impaired in 89% children. Longer epilepsy duration and larger lesion extent were detrimental to presurgical development, which, in turn, determined the postsurgical developmental outcome.ConclusionOur study demonstrates that epilepsy surgery in very young children is safe as well as efficient regarding long-term seizure freedom and antiepileptic drug cessation in selected candidates. Longer epilepsy duration is the only modifiable predictor of impaired adaptive and cognitive development, thus supporting early surgical intervention.Copyright © 2018 by the Congress of Neurological Surgeons.

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