Surgical treatment of drug resistant epilepsy should not be delayed based solely on age, if it is performed at an experienced tertiary center
Epilepsy surgery in infants younger than 3 months is safe and effective, according to a multinational, multicenter study published in the journal Epilepsia. The study found that surgery can stop seizures and lessen the need for medications in babies with drug resistant epilepsy and epileptic encephalopathy. The authors caution, however, that surgeries for this age group require a subspecialized team of experts such as those at select comprehensive pediatric epilepsy centers in tertiary and quaternary pediatric hospitals. These special teams of experts have the concentrated experience and resources to handle complex, technically challenging surgeries on the youngest and smallest children.
Epilepsy surgery in newborns is rare. This type of surgery can represent a major surgical procedure with attendant surgical and anesthetic risks in young patients. To reduce these risks, epilepsy surgery has traditionally been postponed until the child is older. However, living with epilepsy as a young baby carries its own serious risks due to the impact of seizures and medications on neurodevelopment. In this study, the authors show the positive safety profile of ultra-early epilepsy surgery at experienced tertiary centers. Together, this consortium of pediatric neurosurgeons show that waiting is not necessary: epilepsy surgery in young babies can be done safely and effectively.
“We know that babies’ exposure to ongoing seizures and side effects of anti-seizure medications can be highly detrimental to the developing brain,” said co-author Sandi Lam, MD, MBA, Division Head of Neurosurgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and Professor of Neurological Surgery at Northwestern University Feinberg School of Medicine. “Our study found that in order to stop seizures and give newborns the chance to reach their full potential, surgery should not be delayed, as long as it is performed at one of the few centers in the world capable of offering this type of complex procedures safely. Lurie Children’s is one of these specialized centers with experts equipped to treat such complex cases. Excellent surgical technique, anesthesia care, and intensive care treatment are all prerequisite for achieving good results, and at Lurie Children’s we are proud to provide all this to our youngest patients with intractable epilepsy.”
The study included 64 infants who underwent epilepsy surgery before 3 months of age, making it the largest series to date. Excellent epilepsy outcome was achieved in 66 percent of cases over a median follow-up of 41 months. The number of anti-seizure medications was significantly reduced. Postoperative complication rates were comparable to those seen in older children.
“More studies are needed to examine the long-term neurocognitive and neurodevelopmental outcomes of epilepsy surgery in newborns,” said Dr. Lam, who holds the David G. McLone, MD, PhD Professorship in Pediatric Neurosurgery. “Meanwhile, our results give hope for a healthier future for these babies.”
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 220,000 children from 48 states and 49 countries.