Good Results with Early Resective Surgery for Epilepsy

Surgeons are more likely than ever to consider resective procedures in infants and young children who have refractory seizure disorders. Surgical, anesthetic and pediatric care advances have increased this procedure’s safety margin. Freedom from seizures, antiepileptic drug (AED) discontinuation and better development trajectories are admirable goals. Many reports describe good outcomes in infants and young children undergoing resective surgery, but longitudinal data have been published only rarely.

Researchers from Sweden fill this information gap with a study published in the journal Seizure. They followed children operated before age 4 (N=47) for at least 2 and up to 10 years after resective epilepsy surgery. Their results are promising.

This prospective, population based, longitudinal study used data from the Swedish National Epilepsy Surgery Register 1995—2010. The researchers looked at a large array of outcomes including seizure frequency, AED use, neurologic deficits, operation type, histopathological diagnosis and perioperative complications.

Most of the children enrolled in this study developed seizures before their first birthday. The median age at surgery was two years and one month.

Two thirds had neurodevelopmental abnormalities; most had cortical development malformations. The prevailing surgeries included temporal lobe resection, frontal lobe resection and hemispherotomy.

Only one patient had a major perioperative complication, and no patients died.

At 2 years, 45% of children were seizure-free, and 8 of these patients also took no AEDs. At follow-up conducted at between 5 and 10 years, half of the children were seizure-free, and 11 of these patients also took no AEDs. The researchers identified a very low risk of late seizure recurrence. The proportion of seizure-free children entirely off medication increased from 17% to 34% between the 2-year- and the long-term follow-ups. The researchers suggest that it may be possible to taper AED doses earlier than is currently that standard.

Ten additional patients (31%) had 75% fewer seizures after surgery compared to their baseline seizure frequency.

At long term follow-up, 69% of children had discontinued AEDs.

The researchers report that these findings underscore the importance of early referral to epilepsy surgery evaluation when infants and young children are diagnosed with medically intractable epilepsy.