Seizure Control and Developmental Outcomes After Epilepsy Surgery in Infants

Abstract

Background: Managing epilepsy in infants is challenging, even with antiseizure medications, and is associated with developmental delays. This study evaluated epilepsy surgery in infants, focusing on seizure control, developmental outcomes, and quality of life. Method: We conducted a retrospective analysis of infants who underwent epilepsy surgery ≤12 months of age at Great Ormond Street Hospital between January 2007 and October 2023. Data included neuroimaging, cognitive, language, and quality of life assessments. Seizure outcomes were classified using the Engel system. Results: Thirty-eight patients (22 female) were included. The median age at onset was 6 weeks. Patients had structural abnormalities, including hemimegalencephaly (n=12, 31.6%) and focal cortical dysplasia (n=10, 26.3%). Surgery was performed at a median age of 6.5 months (IQR=4 months) and included hemispherotomy (47.4%), lesionectomy/lobectomy (31.5%), and multilobar disconnection (18.4%). Six patients (15%) required a second surgery. After a median follow-up of 4 years (IQR=6 years), 23 patients (60.5%) achieved seizure freedom, and 21 patients (55.3%) discontinued antiseizure medications. Hemiplegia was the most common motor impairment both pre- and post-surgery. Paired pre- and post surgery cognitive data were available for 21 patients, with 53% maintaining and 21% showing improvement in cognitive trajectories. Paired language data were available for 16 patients, with 34% maintaining and 13% showing improvement in language trajectories. Patients achieving seizure freedom exhibited more favourable language trajectories. Post-surgery quality of life data for 13 patients (34.2%) showed scores below normative levels. Conclusion: Epilepsy surgery significantly reduces seizures, but developmental outcomes vary, highlighting the need for ongoing evaluation.