TY - JOUR
T1 - Epilepsy surgery in infants up to 3 months of age
T2 - Safety, feasibility, and outcomes: A multicenter, multinational study
AU - Roth, Jonathan
AU - Constantini, Shlomi
AU - Ekstein, Margaret
AU - Weiner, Howard L.
AU - Tripathi, Manjari
AU - Chandra, Poodipedi Sarat
AU - Cossu, Massimo
AU - Rizzi, Michele
AU - Bollo, Robert J.
AU - Machado, Hélio Rubens
AU - Santos, Marcelo Volpon
AU - Keating, Robert F.
AU - Oluigbo, Chima O.
AU - Rutka, James T.
AU - Drake, James M.
AU - Jallo, George I.
AU - Shimony, Nir
AU - Treiber, Jeffrey M.
AU - Consales, Alessandro
AU - Mangano, Francesco T.
AU - Wisoff, Jeffrey H.
AU - Teresa Hidalgo, Eveline
AU - Bingaman, William E.
AU - Gupta, Ajay
AU - Erdemir, Gozde
AU - Sundar, Swetha J.
AU - Benifla, Mony
AU - Shapira, Vladimir
AU - Lam, Sandi K.
AU - Fallah, Aria
AU - Maniquis, Cassia A.B.
AU - Tisdall, Martin
AU - Chari, Aswin
AU - Cinalli, Giuseppe
AU - Blount, Jeffrey P.
AU - Dorfmüller, Georg
AU - Christine Bulteau,
AU - Uliel-Sibony, Shimrit
N1 - Publisher Copyright:
© 2021 International League Against Epilepsy
PY - 2021/8
Y1 - 2021/8
N2 - Objective: Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on “ultra-early” epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study's goal is to review the safety and efficacy of ultra-early epilepsy surgery performed before the age of 3 months. Methods: To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications. Results: Sixty-four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41 months (19–104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1–3 IQR, p <.0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections). Significance: Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.
AB - Objective: Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on “ultra-early” epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study's goal is to review the safety and efficacy of ultra-early epilepsy surgery performed before the age of 3 months. Methods: To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications. Results: Sixty-four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41 months (19–104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1–3 IQR, p <.0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections). Significance: Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.
UR - http://www.scopus.com/inward/record.url?scp=85108008939&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108008939&partnerID=8YFLogxK
U2 - 10.1111/epi.16959
DO - 10.1111/epi.16959
M3 - Article
C2 - 34128544
AN - SCOPUS:85108008939
SN - 0013-9580
VL - 62
SP - 1897
EP - 1906
JO - Epilepsia
JF - Epilepsia
IS - 8
ER -