Abstracts

Advances in surgical techniques have allowed specialized centers to offer epilepsy surgery to young infants with a satisfactory complication rate. However, surgical experience and outcome of epilepsy surgery in very young infants is limited. The purpose of our study is to review the surgical outcome of epilepsy surgery in patients younger than 6 months., Retrospective analysis of epilepsy surgeries at the Cleveland Clinic Foundation in infants younger than 6 months between 1998 and 2006 (single surgeon series). Following variables were reviewed; demographic data, Magnetic resonance imaging (MRI), duration, frequency and type of epilepsy, antiepileptic medications, [italic]Operative:[/italic] Blood loss in ml and complications, and [italic]Post surgery:[/italic] Seizure outcome at 6 mo follow-up., Total of 15 patients underwent epilepsy surgery. Anatomical (n=4) and functional (n=7) hemispherectomy, lobectomy (n=3), and lesionectomy (n=1) at median age of 3 months (range 1.5 to 6) for catastrophic epilepsy surgery due to cortical dysplasia (n=15). Seizure onset was at mean age of 8 [underline]+[/underline] 13.1 days, with duration of 2.7 [underline]+[/underline] 1.3 months, 7 patients were in status epilepticus and the remaining had seizure frequency of 8.3 [underline]+[/underline] 5. 7 per day, refractory to antiepileptic drugs 3.6 [underline]+[/underline] 0.8. Five patients had right, 6 had left hemispheric, and 4 had focal epilepsy. MRI revealed epileptogenic lesion that correlated with EEG and clinical features. Histopathologic analysis of resected tissue revealed cortical dysplasia in all patients. The mean body weight at the time of surgery was 7 [underline]+[/underline] 1.7 Kgs, estimated blood loss was 54.5 [underline]+[/underline] 36.6 ml/kg, length of ICU stay 4 [underline]+[/underline] 1.6 days. Immediate post-operative complications were; aseptic meningitis (n=3) and middle cerebral artery territory stroke (n=1, in the region of the epileptogenic zone) in the setting of preexisting hemiparesis. Seizure outcome at 6 months follow-up; 11 were seizure free (73.3 %, Engel outcome class - EC I), 1 had seizures for 3 months ( 6.6%, EC II), 2 had worthwhile improvement (14.06%, EC III), and all had reduced use of antiepileptics 1.9 [underline]+[/underline] 0.5., Our data show favorable surgical outcome. Epilepsy surgery when necessary for catastrophic epilepsy in very young infants( [lt] 6 months ) should be offered in highly specialized centers with extensive pediatric epilepsy surgery experience.,