Surgery for catastrophic epilepsy in infants 6 months of age and younger

Clinical article

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Object

Few data are available concerning efficacy and safety of surgery for catastrophic epilepsy in the first 6 months of life.

Methods

The authors retrospectively analyzed epilepsy surgeries in 15 infants ranging in age from 1.5 to 6 months (median 4 months) and weight from 4 to 10 kg (median 7 kg) who underwent anatomical (4 patients) or functional (7 patients) hemispherectomy, or frontal (1 patient), frontoparietal (2 patients), or parietooccipital (1 patient) resection for life-threatening catastrophic epilepsy due to malformation of cortical development.

Results

No patient died. Intraoperative complications included an acute ischemic infarction with hemiparesis in our youngest, smallest infant. The most frequent complication was blood loss requiring transfusion, which was encountered in every case. The estimated blood loss was 3–214% (median 63%) of the total blood volume. At maximum follow-up of 6–121 months (median 60 months), 46% were seizure free.

Conclusions

Epilepsy surgery may be effective in young infants as it is in older children. However, intraoperative blood loss and risk of permanent postoperative neurological deficits present significant challenges.

Abbreviations used in this paper: EEG = electroencephalography; ICU = intensive care unit; LOS = length of stay; MCA = middle cerebral artery; MCD = malformation of cortical development; TSC = tuberous sclerosis complex.

Article Information

Address correspondence to: Shaila Gowda, M.D., Department of Neurology, Providence Park Hospital, 26850 Providence Parkway, Suite 210 Novi, Michigan 48374. email: ssrinath03@yahoo.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case. 1. Left: Ictal onset from the right hemisphere with maximum noted in the right frontal region. Right: Ictal EEG obtained 30 seconds later.

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    Case 1. Preoperative (left) and postoperative (right) MR images showing a right frontal malformation and resection showing a right MCA infarction.

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