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Semin Neurol
DOI: 10.1055/a-2519-2923
Review Article

Unique Surgical Challenges in Early Life Epilepsy

Michael Scott Perry 
1   Department of Neurology, Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas
,
Daniel Hansen
2   Department of Neurosurgery, Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas
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Abstract

The incidence of epilepsy is highest at the extremes of age. Drug resistance is present in approximately one-third of people with epilepsy but occurs at higher than average rates in children with seizure onset before age 3 years, owing to a variety of etiologies unique to this age group. Epilepsy surgery is an effective therapeutic option for drug-resistant epilepsy but is vastly underutilized. Epilepsy surgery in children under age 3 comes with distinct clinical challenges related to brain anatomy, evolving developmental maturation, and limitations of evaluation and surgical strategies. However, epilepsy surgery can lead to seizure freedom or significant seizure reduction in this age group. Early seizure control may have a significant positive impact on long-term cognitive development, making urgency of surgical referral of immense importance. This review highlights available evidence on the safety and efficacy of epilepsy surgery in early-life epilepsy, identifying barriers to surgical therapy, describing utilization of available evaluation and surgical strategies, and examining risks and benefits of earlier surgical consideration in this vulnerable population.

Keywords

drug-resistant epilepsy - epilepsy surgery - surgical morbidity


Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Symonds JD, Elliott KS, Shetty J. et al. Early childhood epilepsies: epidemiology, classification, aetiology, and socio-economic determinants. Brain 2021; 144 (09) 2879-2891
    CrossrefPubMedSuche in Google Scholar
  • 2 Berg AT, Zelko FA, Levy SR, Testa FM. Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes: a prospective cohort study. Neurology 2012; 79 (13) 1384-1391
    CrossrefPubMedSuche in Google Scholar
  • 3 Berg AT, Wusthoff C, Shellhaas RA. et al. Immediate outcomes in early life epilepsy: a contemporary account. Epilepsy Behav 2019; 97: 44-50
    CrossrefPubMedSuche in Google Scholar
  • 4 Wirrell E, Wong-Kisiel L, Mandrekar J, Nickels K. Predictors and course of medically intractable epilepsy in young children presenting before 36 months of age: a retrospective, population-based study. Epilepsia 2012; 53 (09) 1563-1569
    CrossrefPubMedSuche in Google Scholar
  • 5 Vignoli A, Peron A, Turner K. et al. Long-term outcome of epilepsy with onset in the first three years of life: findings from a large cohort of patients. Eur J Paediatr Neurol 2016; 20 (04) 566-572
    CrossrefPubMedSuche in Google Scholar
  • 6 Research Protocol. Management of infantile epilepsy. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Accessed July 25, 2021 at: https://effectivehealthcare.ahrq.gov/products/management-infantile-epilepsy/research/protocol
    PubMed
  • 7 Samanta D, Ostendorf AP, Willis E. et al. Underutilization of epilepsy surgery: part I: a scoping review of barriers. Epilepsy Behav 2021; 117: 107837
    CrossrefPubMedSuche in Google Scholar
  • 8 Samanta D, Singh R, Gedela S, Scott Perry M, Arya R. Underutilization of epilepsy surgery: part II: strategies to overcome barriers. Epilepsy Behav 2021; 117: 107853
    CrossrefPubMedSuche in Google Scholar
  • 9 Burneo JG, Shariff SZ, Liu K, Leonard S, Saposnik G, Garg AX. Disparities in surgery among patients with intractable epilepsy in a universal health system. Neurology 2016; 86 (01) 72-78
    CrossrefPubMedSuche in Google Scholar
  • 10 Baud MO, Perneger T, Rácz A. et al. European trends in epilepsy surgery. Neurology 2018; 91 (02) e96-e106
    PubMedSuche in Google Scholar
  • 11 Geerts A, Arts WF, Stroink H. et al. Course and outcome of childhood epilepsy: a 15-year follow-up of the Dutch Study of Epilepsy in Childhood. Epilepsia 2010; 51 (07) 1189-1197
    CrossrefPubMedSuche in Google Scholar
  • 12 Duchowny M, Jayakar P, Resnick T. et al. Epilepsy surgery in the first three years of life. Epilepsia 1998; 39 (07) 737-743
    CrossrefPubMedSuche in Google Scholar
  • 13 Jenny B, Smoll N, El Hassani Y. et al. Pediatric epilepsy surgery: could age be a predictor of outcomes?. J Neurosurg Pediatr 2016; 18 (02) 235-241
    CrossrefPubMedSuche in Google Scholar
  • 14 Loddenkemper T, Holland KD, Stanford LD, Kotagal P, Bingaman W, Wyllie E. Developmental outcome after epilepsy surgery in infancy. Pediatrics 2007; 119 (05) 930-935
    CrossrefPubMedSuche in Google Scholar
  • 15 Gowda S, Salazar F, Bingaman WE. et al. Surgery for catastrophic epilepsy in infants 6 months of age and younger. J Neurosurg Pediatr 2010; 5 (06) 603-607
    CrossrefPubMedSuche in Google Scholar
  • 16 Dunkley C, Kung J, Scott RC. et al. Epilepsy surgery in children under 3 years. Epilepsy Res 2011; 93 (2-3): 96-106
    CrossrefPubMedSuche in Google Scholar
  • 17 Sugimoto T, Otsubo H, Hwang PA, Hoffman HJ, Jay V, Snead III OC. Outcome of epilepsy surgery in the first three years of life. Epilepsia 1999; 40 (05) 560-565
    CrossrefPubMedSuche in Google Scholar
  • 18 Wyllie E, Comair YG, Kotagal P, Raja S, Ruggieri P. Epilepsy surgery in infants. Epilepsia 1996; 37 (07) 625-637
    CrossrefPubMedSuche in Google Scholar
  • 19 Perry MS, Shandley S, Perelman M. et al. Surgical evaluation in children <3 years of age with drug-resistant epilepsy: Patient characteristics, diagnostic utilization, and potential for treatment delays. Epilepsia 2022; 63 (01) 96-107
    CrossrefPubMedSuche in Google Scholar
  • 20 Barba C, Pelliccia V, Grisotto L. et al. Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: a multicenter study. Epilepsia Open 2024; 9 (04) 1382-1392
    CrossrefPubMedSuche in Google Scholar
  • 21 Yu H, Liu Q, Wang R. et al. Long-term seizure and developmental outcomes of epilepsy surgery in children under 3 years old: A single-center study of 113 patients. CNS Neurosci Ther 2024; 30 (01) e14481
    CrossrefPubMedSuche in Google Scholar
  • 22 Makridis KL, Klotz KA, Ramantani G. et al. Epilepsy surgery in early infancy: a retrospective, multicenter study. Epilepsia Open 2023; 8 (03) 1182-1189
    CrossrefPubMedSuche in Google Scholar
  • 23 Kumar RM, Koh S, Knupp K, Handler MH, O'Neill BR. Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy. Childs Nerv Syst 2015; 31 (09) 1479-1491
    CrossrefPubMedSuche in Google Scholar
  • 24 Ramantani G, Kadish NE, Strobl K. et al. Seizure and cognitive outcomes of epilepsy surgery in infancy and early childhood. Eur J Paediatr Neurol 2013; 17 (05) 498-506
    CrossrefPubMedSuche in Google Scholar
  • 25 Steinbok P, Gan PYC, Connolly MB. et al. Epilepsy surgery in the first 3 years of life: a Canadian survey. Epilepsia 2009; 50 (06) 1442-1449
    CrossrefPubMedSuche in Google Scholar
  • 26 Maton B, Jayakar P, Resnick T, Morrison G, Ragheb J, Duchowny M. Surgery for medically intractable temporal lobe epilepsy during early life. Epilepsia 2008; 49 (01) 80-87
    CrossrefPubMedSuche in Google Scholar
  • 27 Gröppel G, Dorfer C, Dressler A. et al. Epilepsy surgery in infants: safety issues and developmental outcome. Wien Klin Wochenschr 2018; 130 (9-10): 341-348
    CrossrefPubMedSuche in Google Scholar
  • 28 Kadish NE, Bast T, Reuner G. et al. Epilepsy surgery in the first 3 years of life: predictors of seizure freedom and cognitive development. Neurosurgery 2019; 84 (06) E368-E377
    CrossrefPubMedSuche in Google Scholar
  • 29 Iwasaki M, Iijima K, Kawashima T. et al. Epilepsy surgery in children under 3 years of age: surgical and developmental outcomes. J Neurosurg Pediatr 2021; 28 (04) 395-403
    CrossrefPubMedSuche in Google Scholar
  • 30 Coryell J, Singh R, Ostendorf AP. et al. Epilepsy surgery in children with genetic etiologies: a prospective evaluation of current practices and outcomes. Seizure 2023; 113: 6-12
    CrossrefPubMedSuche in Google Scholar
  • 31 Jeno M, Zimmerman B, Shandley S. et al. Pediatric palliative epilepsy surgery: a report from the Pediatric Epilepsy Research Consortium (PERC) Surgery Database. Pediatr Neurol 2024; 157: 70-78
    CrossrefPubMedSuche in Google Scholar
  • 32 Cohen NT, Chang P, You X. et al. Prevalence and risk factors for pharmacoresistance in children with focal cortical dysplasia-related epilepsy. Neurology 2022; 99 (18) e2006-e2013
    CrossrefPubMedSuche in Google Scholar
  • 33 Pindrik J, Hoang N, Smith L. et al. Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy. Neurosurg Focus 2018; 45 (03) E3
    CrossrefPubMedSuche in Google Scholar
  • 34 Obeid M, Wyllie E, Rahi AC, Mikati MA. Approach to pediatric epilepsy surgery: state of the art, part I: general principles and presurgical workup. Eur J Paediatr Neurol 2009; 13 (02) 102-114
    CrossrefPubMedSuche in Google Scholar
  • 35 Shields WD, Shewmon DA, Chugani HT, Peacock WJ. Treatment of infantile spasms: medical or surgical?. Epilepsia 1992; 33 (Suppl. 04) S26-S31
    CrossrefPubMedSuche in Google Scholar
  • 36 Eltze CM, Chong WK, Bhate S, Harding B, Neville BG, Cross JH. Taylor-type focal cortical dysplasia in infants: some MRI lesions almost disappear with maturation of myelination. Epilepsia 2005; 46 (12) 1988-1992
    CrossrefPubMedSuche in Google Scholar
  • 37 Barkovich AJ. Concepts of myelin and myelination in neuroradiology. AJNR Am J Neuroradiol 2000; 21 (06) 1099-1109
    PubMedSuche in Google Scholar
  • 38 Gaillard WD, Chiron C, Cross JH. et al; ILAE, Committee for Neuroimaging, Subcommittee for Pediatric. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009; 50 (09) 2147-2153
    CrossrefPubMedSuche in Google Scholar
  • 39 Hertz-Pannier L, Chiron C, Véra P. et al. Functional imaging in the work-up of childhood epilepsy. Childs Nerv Syst 2001; 17 (4-5): 223-228
    CrossrefPubMedSuche in Google Scholar
  • 40 Kakisaka Y, Haginoya K, Ishitobi M. et al. Utility of subtraction ictal SPECT images in detecting focal leading activity and understanding the pathophysiology of spasms in patients with West syndrome. Epilepsy Res 2009; 83 (2-3): 177-183
    CrossrefPubMedSuche in Google Scholar
  • 41 Kudr M, Krsek P, Maton B. et al. Ictal SPECT in localizing the epileptogenic zone in infants with cortical dysplasia. Epileptic Disord 2016; 18 (4) 384-390
    CrossrefPubMedSuche in Google Scholar
  • 42 Chugani HT, Shewmon DA, Shields WD. et al. Surgery for intractable infantile spasms: neuroimaging perspectives. Epilepsia 1993; 34 (04) 764-771
    CrossrefPubMedSuche in Google Scholar
  • 43 Snead III OC, Chen LS, Mitchell WG. et al. Usefulness of [18F]fluorodeoxyglucose positron emission tomography in pediatric epilepsy surgery. Pediatr Neurol 1996; 14 (02) 98-107
    CrossrefPubMedSuche in Google Scholar
  • 44 Shibata S, Mosher JC, Kotagal P, Gupta A, Alexopoulos AV, Burgess RC. Magnetoencephalography recordings in infants using a standard-sized array: technical adequacy and diagnostic yield. J Clin Neurophysiol 2017; 34 (05) 461-468
    CrossrefPubMedSuche in Google Scholar
  • 45 Garcia-Tarodo S, Funke M, Caballero L, Zhu L, Shah MN, Von Allmen GK. Magnetoencephalographic recordings in infants: a retrospective analysis of seizure-focus yield and postsurgical outcomes. J Clin Neurophysiol 2018; 35 (06) 454-462
    CrossrefPubMedSuche in Google Scholar
  • 46 Berl MM, Smith ML. Bulteau C and the Task Force for Pediatric Epilepsy Surgery of the ILAE Commission of Pediatrics, Surgical Therapies. ILAE survey of neuropsychology practice in pediatric epilepsy surgery evaluation. Epileptic Disord 2017; 19 (02) 166-177
    CrossrefPubMedSuche in Google Scholar
  • 47 Berl MM, Koop JI, Ailion A. et al; PERC Surgery Workgroup. Leveraging expertise and optimizing clinical research: Initial success of a pediatric epilepsy surgery collaborative. Epilepsia 2023; 64 (06) 1554-1567
    CrossrefPubMedSuche in Google Scholar
  • 48 Papadelis C, Chen YH. Pediatric Magnetoencephalography in clinical practice and research. Neuroimaging Clin N Am 2020; 30 (02) 239-248
    CrossrefPubMedSuche in Google Scholar
  • 49 Altman NR, Bernal B. Pediatric applications of functional magnetic resonance imaging. Pediatr Radiol 2015; 45 (Suppl. 03) S382-S396
    CrossrefPubMedSuche in Google Scholar
  • 50 Vadivelu S, Wolf VL, Bollo RJ, Wilfong A, Curry DJ. Resting-state functional MRI in pediatric epilepsy surgery. Pediatr Neurosurg 2013; 49 (05) 261-273
    CrossrefPubMedSuche in Google Scholar
  • 51 Narayana S, Mudigoudar B, Babajani-Feremi A, Choudhri AF, Boop FA. Successful motor mapping with transcranial magnetic stimulation in an infant: a case report. Neurology 2017; 89 (20) 2115-2117
    CrossrefPubMedSuche in Google Scholar
  • 52 Kim LH, Parker JJ, Ho AL. et al. Postoperative outcomes following pediatric intracranial electrode monitoring: a case for stereoelectroencephalography (SEEG). Epilepsy Behav 2020; 104 (Pt A): 106905
    CrossrefPubMedSuche in Google Scholar
  • 53 Abel TJ, Varela Osorio R, Amorim-Leite R. et al. Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique. J Neurosurg Pediatr 2018; 22 (01) 37-46
    CrossrefPubMedSuche in Google Scholar
  • 54 Desai A, Sharma A, Sundar SJ. et al. The impact of skull thickness on pediatric stereoencephalography electrode implantation and technical considerations. J Neurosurg Pediatr 2023; 32 (05) 562-568
    CrossrefPubMedSuche in Google Scholar
  • 55 Wabulya A, Nacionales D, Shin HW, Abumoussa A, Hadar E. Feasibility of stereo electroencephalogram (SEEG) with little to no scalp bone; a case report. Epilepsy Behav Rep 2020; 15: 100394
    CrossrefPubMedSuche in Google Scholar
  • 56 Karsonovich T, Alexander A, Graber S, O'Neill BR. Placement of leads for stereotactic electroencephalography without the use of anchor bolts: technical note. J Neurosurg Pediatr 2020; 27 (03) 253-258
    CrossrefPubMedSuche in Google Scholar
  • 57 Gajawelli N, Deoni S, Shi J. et al. Neurocranium thickness mapping in early childhood. Sci Rep 2020; 10 (01) 16651
    CrossrefPubMedSuche in Google Scholar
  • 58 Berry C, Sandberg DI, Hoh DJ, Krieger MD, McComb JG. Use of cranial fixation pins in pediatric neurosurgery. Neurosurgery 2008; 62 (04) 913-918 , discussion 918–919
    CrossrefPubMedSuche in Google Scholar
  • 59 Wong WB, Haynes RJ. Osteology of the pediatric skull. Considerations of halo pin placement. Spine 1994; 19 (13) 1451-1454
    CrossrefPubMedSuche in Google Scholar
  • 60 Arkader A, Hosalkar HS, Drummond DS, Dormans JP. Analysis of halo-orthoses application in children less than three years old. J Child Orthop 2007; 1 (06) 337-344
    CrossrefPubMedSuche in Google Scholar
  • 61 Domenech-Fernandez P, Yamane J, Domenech J. et al. Analysis of skull bone thickness during growth: an anatomical guide for safe pin placement in halo fixation. Eur Spine J 2021; 30 (02) 410-415
    CrossrefPubMedSuche in Google Scholar
  • 62 Roseff SD, Luban NL, Manno CS. Guidelines for assessing appropriateness of pediatric transfusion. Transfusion 2002; 42 (11) 1398-1413
    CrossrefPubMedSuche in Google Scholar
  • 63 Roth J, Constantini S, Ekstein M. et al. Epilepsy surgery in infants up to 3 months of age: Safety, feasibility, and outcomes: a multicenter, multinational study. Epilepsia 2021; 62 (08) 1897-1906
    CrossrefPubMedSuche in Google Scholar
  • 64 Braun KPJ, Cross JH. Pediatric epilepsy surgery: the earlier the better. Expert Rev Neurother 2018; 18 (04) 261-263
    CrossrefPubMedSuche in Google Scholar
  • 65 Devlin AM, Cross JH, Harkness W. et al. Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain 2003; 126 (Pt 3): 556-566
    CrossrefPubMedSuche in Google Scholar
  • 66 van Empelen R, Jennekens-Schinkel A, Gorter JW, Volman MJ, van Nieuwenhuizen O, Helders PJ. Dutch Collaborative Epilepsy Surgery Programme. Epilepsy surgery does not harm motor performance of children and adolescents. Brain 2005; 128 (Pt 7): 1536-1545
    CrossrefPubMedSuche in Google Scholar
  • 67 Simasathien T, Vadera S, Najm I, Gupta A, Bingaman W, Jehi L. Improved outcomes with earlier surgery for intractable frontal lobe epilepsy. Ann Neurol 2013; 73 (05) 646-654
    CrossrefPubMedSuche in Google Scholar
  • 68 Englot DJ, Berger MS, Barbaro NM, Chang EF. Factors associated with seizure freedom in the surgical resection of glioneuronal tumors. Epilepsia 2012; 53 (01) 51-57
    CrossrefPubMedSuche in Google Scholar
  • 69 Englot DJ, Han SJ, Lawton MT, Chang EF. Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations. J Neurosurg 2011; 115 (06) 1169-1174
    CrossrefPubMedSuche in Google Scholar
  • 70 Freitag H, Tuxhorn I. Cognitive function in preschool children after epilepsy surgery: rationale for early intervention. Epilepsia 2005; 46 (04) 561-567
    CrossrefPubMedSuche in Google Scholar
  • 71 Fernandez L, Gedela S, Tamber M, Sogawa Y. Vagus nerve stimulation in children less than 3 years with medically intractable epilepsy. Epilepsy Res 2015; 112: 37-42
    CrossrefPubMedSuche in Google Scholar
  • 72 Elliott RE, Rodgers SD, Bassani L. et al. Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases. J Neurosurg Pediatr 2011; 7 (05) 491-500
    CrossrefPubMedSuche in Google Scholar
  • 73 Orosz I, McCormick D, Zamponi N. et al. Vagus nerve stimulation for drug-resistant epilepsy: a European long-term study up to 24 months in 347 children. Epilepsia 2014; 55 (10) 1576-1584
    CrossrefPubMedSuche in Google Scholar