Abstracts

Rationale: Epilepsy has the highest prevalence at the two extremes of life. Surgical resection of the temporal lobe is the surgery most often carried out in persons with epilepsy (PWE) for Medial Temporal Epilepsy (MTS). This condition is however rarely seen in the very young where neocortical epilepsy is most frequently seen. We reviewed the seizure related characteristics of young children leading up to and at the time. Methods: The epilepsy surgery database was reviewed for children under 5 years of age from 2012 to present. Age of onset, duration of epilepsy, seizure type, type of surgery and outcome were reviewed. Results: 196 surgeries were completed. 92 were VNS placements (60 naïve patients and 30 VNS replacements). 104 resections, disconnections or ablations were done, 23 of which were in children under 5 years of age. Ages ranged from seven weeks to five years. Duration of epilepsy prior to surgery ranged from 1.5 months to 4 years. All patients tried at least three AED's and one had tried eight. 10/23 presented with Spasms or hemi-spasms. 7/23 had functional hemispherectomy/hemispherotomy, one a corpus callosotomy and VNS placed, two thermal ablation and the others lesionectomies. 17/23 (73%), one mth to 2.5 years follow-up, are seizure free. 3 children have >75% reduction, one > 50% reduction, a child with TS was seizure free for the managed seizure type but has another active focus, and the last patient was just completed. Conclusions: The underlying causes of seizures are quite varied in young children though many present similarly with Spasms. Epilepsy surgery, as is often experienced in older children and adults, can significantly reduce or stop seizures. This can be seen even in patients with complex structural cortical malformations or abnormalities. One should advocate for early surgery in young children with Pharmacoresistant Epilepsy.