Epilepsy Surgery in the First Months of Life

Background: Resective epilepsy surgery aims to achieve seizure freedom in patients with medically refractory epilepsy. Furthermore, cognition and behavior might improve after the procedure. Thus, candidates should be referred as early as possible for presurgical evaluation. While there is plenty of data of epilepsy surgery around the first year of life, data are limited for cases who underwent surgery significant earlier, i.e. in the first months of life.

Methods: We present a case series of two female patients who underwent epilepsy surgery at the age of 2,5 and 4 months. EEG and MRI data will be presented as well as both seizure and neurodevelopmental outcome of the patients.

Results: Both patients suffered from medically refractory seizures from the first days of life. Patient #1 revealed a right frontal cortical dysplasia with a peculiar MRI pattern and epilepsy surgery (lesionectomy) was performed at the age of 2,5 months due to congruent findings of EEG seizure onset zone and MRI lesion. The patient is seizure free without medication (Engel Class Ia) and is normally developed three years after surgery. Patient #2 had an extended malformation of cortical development of the left hemisphere and was referred for hemispherotomy at the age of 4 months. At the age of six months, she was still on medication, had significant seizure relief (Engel Class Ib) and showed incomplete right sided hemiparesis.

Discussion: Resective epilepsy surgery/disconnection procedures might be performed as early as within the first months of life when indicated. This is underlined by recent investigations showing that candidates with medically refractory seizures occurring in the first years of life who are operated before the first years of life have a better neurodevelopmental outcome than those patients operated beyond this age.

No conflict of interest has been declared by the author(s).