Jonathan Roth1, Shlomi Constantini1, Margaret Ekstein2, Howard L Weiner3,4, Manjari Tripathi5, Poodipedi Sarat Chandra5, Massimo Cossu6, Michele Rizzi6, Robert J Bollo7, Hélio Rubens Machado8, Marcelo Volpon Santos8, Robert F Keating9, Chima O Oluigbo9, James T Rutka10, James M Drake10, George I Jallo11,12, Nir Shimony12,13, Jeffrey M Treiber3,4, Alessandro Consales14, Francesco T Mangano15, Jeffrey H Wisoff16, Eveline Teresa Hidalgo16, William E Bingaman17, Ajay Gupta18, Gozde Erdemir18, Swetha J Sundar17, Mony Benifla19, Vladimir Shapira19, Sandi K Lam20,21, Aria Fallah22, Cassia A B Maniquis22, Martin Tisdall23, Aswin Chari23, Giuseppe Cinalli24, Jeffrey P Blount25, Georg Dorfmüller26, Shimrit Uliel-Sibony27. 1. Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. 2. Pediatric Anesthesia Unit, Department of Anesthesia, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. 3. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA. 4. Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA. 5. Center of Excellence for Epilepsy and MEG, AIIMS, New Delhi, India. 6. "C. Munari" Centre for Epilepsy Surgery, Niguarda Hospital, Milan, Italy. 7. Division of Pediatric Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA. 8. Pediatric Neurosurgery, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil. 9. Department of Neurosurgery, Children's National Medical Center, Washington, DC, USA. 10. Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada. 11. Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA. 12. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 13. Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA. 14. Department of Pediatric Neurosurgery, IRRCS Istituto Giannina Gaslini, Genoa, Italy. 15. Department of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 16. Division of Pediatric Neurosurgery, Hassenfeld Children's Hospital, NYU Langone Health, New York, NY, USA. 17. Department of Neurological Surgery, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA. 18. Department of Neurology, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA. 19. Pediatric Neurosurgery Department, Rambam Health Care Campus, Haifa, Israel. 20. Department of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA. 21. Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 22. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 23. Department of Neurosurgery, Great Ormond Street Hospital & Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK. 24. Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy. 25. Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Al, USA. 26. Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France. 27. Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Abstract
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.
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.
Authors: Konstantin L Makridis; Christine Prager; Anna Tietze; Deniz A Atalay; Sebastian Triller; Christian E Elger; Ulrich-Wilhelm Thomale; Angela M Kaindl Journal: Front Neurol Date: 2021-12-24 Impact factor: 4.003
Authors: Andres Jimenez-Gomez; Kristen S Fisher; Kevin X Zhang; Chunyan Liu; Qin Sun; Veeral S Shah Journal: Front Hum Neurosci Date: 2022-08-16 Impact factor: 3.473