Surgery should not be postponed in neonates with epilepsy, study says

Performing epilepsy surgery in the first few months of life of infants with epilepsy is beneficial, resulting in good seizure control, as shown in a recent study. More importantly, when done by highly experienced teams, the procedure does not pose an increased risk of permanent morbidity.

The study looked at 64 infants who underwent “ultra-early” (in the first 3 months of life) surgery for epilepsy. Data on patient characteristics, surgical details, epilepsy outcome, and complications were collected and analysed.

In the cohort, the most common cause of epilepsy was cortical dysplasia (n=28), followed by hemimegalencephaly (n=17) and tubers (n=5). Most of the infants received hemispheric surgeries (48 procedures). There were two cases that were intentionally staged, and one was unexpectedly aborted.

Blood products were given to nearly all patients. There were no documented incidences of perioperative deaths and major unexpected permanent morbidities. Meanwhile, a quarter of the infants who underwent hemispheric surgeries developed hydrocephalus.

In terms of efficacy, 66 percent of the patients achieved excellent epilepsy outcome (International League Against Epilepsy grade I) over a median follow-up of 41 months. There was a parallel reduction in the number of antiseizure medications (median, two drugs; p<0.0001).

Finally, the type of surgery (hemispheric or more limited resections) did not significantly influence outcomes.

The findings suggest that epilepsy surgery is safe and should not be postponed to treat drug-resistant epilepsy in very young infants.