儿童难治性癫痫门诊生酮饮食治疗与住院生酮饮食治疗的疗效、有效性及长期保留率比较分析

目的观察并比较分析门诊生酮饮食(Ketogenic diet,KD)与住院KD治疗儿童难治性癫痫的疗效、有效性及长期保留率。方法回顾性分析2014年6月-2015年12月在重庆医科大学附属儿童医院神经康复中心门诊部收集的44例采用改良经典KD治疗的难治性癫痫患儿随访情况。通过3、6、12个月门诊随访,记录发作控制及不良反应,与同期第三军医大学新桥医院神经康复科住院KD治疗难治性癫痫患儿的疗效、有效性及保留率进行比较分析。结果随访12个月,44例患儿中有34例完成观察,其中15例完全缓解,2例显著缓解,5例部分缓解,12例发作无明显变化,总有效率为64.7%(22/34),KD治疗12个月的保留率为71%。同期住院患儿104例中有18例完成观察,其中3例完全缓解,2例部分缓解,13例发作无明显变化,总有效率为27.8%(5/18),KD治疗12个月的保留率为17.3%。结论门诊KD治疗儿童难治性癫痫疗效较好,其有效性、长期保留率较住院KD治疗高,为国内因床位紧张而无法住院接受KD治疗的难治性癫痫患儿提供了较好的方法。     

吡仑帕奈与奥卡西平单药治疗成人局灶性癫痫的有效性和安全性研究

目的 比较吡仑帕奈（Perampanel,PER）和奥卡西平（Oxcarbazepine,OXC）单药治疗成人新诊断局灶性癫痫的有效性和安全性。方法 纳入清远市人民医院2021年8月—2022年10月新诊断的62例成人局灶性癫痫患者,年龄18～79岁,平均（40.53±16.69）岁,随机分为PER组和OXC组。两组均随访12个月,并分析第3、6、12个月的癫痫无发作率、有效率、药物保留率,以及两组的不良反应情况。结果 PER组32例,OXC组30例。3个月时PER组癫痫无发作率62.5%、有效率71.9%、药物保留率87.5%;OXC组癫痫无发作率70.0%、有效率86.7%、药物保留率93.3%。6个月时PER组癫痫无发作率53.1%、有效率65.6%、保留率75.0%;OXC组癫痫无发作率66.7%、有效率73.3%、保留率83.3%。12个月时PER组癫痫无发作率43.8%、有效率46.9%、保留率53.1%;OXC组癫痫无发作率66.7%、有效率66.7%、保留率70.0%。PER组与OXC组不良反应发生率分别为15.6%和16.7%,两组最常见的不良反应均为头晕和嗜睡,无严...     

奥卡西平治疗4岁以下儿童症状性癫痫长程保留率的临床研究

目的分析奥卡西平(Oxcabazepine,OXC)治疗4岁以下儿童症状性癫痫的疗效、耐受性及长程保留率,以期为儿童症状性癫痫提供更多的思路与方案,以指导临床用药。方法选取2009年1月-2015年6月就诊于重庆医科大学附属儿童医院神经内科门诊的89例儿童症状性癫痫患者,给予OXC首用或添加用药治疗。OXC的起始剂量为10 mg/(kg·d),经3~4周加至目标剂量,最大剂量≤60 mg/(kg·d),平均剂量为(34.00±8.59)mg/(kg·d)。分别于3、6、12个月,2、3年随访患儿的服药情况、发作频率、药物不良反应及脑电图(EEG)情况。结果 89例患儿服用OXC后6、12个月,2、3年总有效率(发作频率较基线期减少≥50%)分别为56.5%、55.3%、44.7%、24.7%,完全缓解率(发作频率较基线期减少≥100%)分别为36.5%、34.1%、29.4%、16.5%。在服药期间,16例(18.0%)患儿至少出现了一种不良反应,主要不良反应有嗜睡8例(42.1%)、皮疹3例(15.8%)。大部分不良反应轻微,其中8例因不能耐受不良反应而停药。3、6、12个月,2、3年的保留率分别为95.5%、87.6%、75.3%、56.2%、25.8%。主要停药原因有缺乏疗效36例(54.5%)、时间终点10例(15.2%)、不能耐受8例(12.1%)、控制可5例(7.6%)、失访3例(4.5%)。COX回归分析示患儿起病年龄与停药具有相关性(P0.05)。结论 OXC作为一种新型的抗癫痫药物在治疗4岁以下症状性癫痫患儿的过程中不良反应轻微,具有较好的耐受性,但远期有效性和长期保留率较低。症状性癫痫患儿使用OXC后若疗效欠佳,需综合考虑各方面因素,及时调整用药,以提高远期的效果及保留率。     

左乙拉西坦单药治疗小儿癫痫的自身对照研究

目的研究左乙拉西坦作为单药治疗不同类型癫痫患儿的临床疗效和安全性。方法采用前瞻性研究,对62例不同类型癫痫患儿进行左乙拉西坦单药治疗。左乙拉西坦起始剂量为20 mg/(kg.d),分两次服用,每两周增加10 mg/(kg.d),维持剂量30～40 mg/(kg.d)。稳定期:维持加量期12周,每个月观察1次,以治疗前3个月的发病频率为基础,完成了6个月的观察期,随访6～24个月(平均随访12.8个月),观察发作频率的变化及不良反应。结果 62例入选患儿,完全控制发作38例,占61.3%,显效8例,占12.9%;有效9例,占14.5%;无效4例,占6.5%;加重3例,占4.8%。总有效率为88.7%,两年治疗保留率为72%。左乙拉西坦治疗前后发作频率改变有统计学意义(P0.005)。结论左乙拉西坦作为单药治疗小儿各型癫痫有良好疗效及安全性。     

脆弱拟杆菌(BF839)辅助治疗难治性癫痫有效性的初步临床研究

目的研究脆弱拟杆菌(BF839)辅助治疗难治性癫痫的有效性和安全性以及共患病的改善情况,以寻找新方法治疗难治性癫痫。方法纳入2019年4月—2019年10月在广州医科大学附属第二医院神经内科癫痫专病门诊就诊的47例难治性癫痫患者,辅助添加BF839治疗。比较1～4个月治疗期间每月(28天)癫痫发作频率相对于干预前基线的中位降低百分比;反应率(癫痫发作减少≥50%的患者比例);干预12个月的无发作率和保留率,并初步观察不良反应与共患病变化。结果干预后1～4个月包括所有类型的总发作频率月均中位降低百分比为-53.5%(P=0.002),反应率为61.1%(22/36);12个月无发作率是8.5%(4/47);12个月的保留率是57.4%(27/47);不良反应为腹泻4.3%(2/47)、便秘4.3%(2/47),48.9%(23/47)患者报告共患病好转,其中认知改善21.2%(10/47)。结论脆弱拟杆菌(BF839)可安全、有效辅助治疗难治性癫痫,还有利于改善共患病,这是世界首次报道口服单一肠道菌株可能有效治疗难治性癫痫的研究,具有重要意义。     

儿童癫（癎）首选丙戊酸钠口服液的保留率观察研究

目的 观察丙戊酸钠口服液在儿童癫（癎）患者中应用情况,为其选药提供可靠依据.方法 选择2005-2010年新乡医学院第二附属医院神经内科门诊和病房的儿童病人257例,均为我院首诊且首选丙戊酸钠口服液治疗.追踪观察2 a,每6个月归纳分析1次,采用百分比分析法来计算保留率.结果 6个月保留率是77.43%,12个月保留率是74.32%,18个月保留率73.93%,24个月保留率仍是73.93%.结论 丙戊酸钠口服液在儿童癫（癎）患者中应用比较容易接受.     

吡仑帕奈治疗儿童难治性癫痫的疗效和安全性研究

目的评估吡仑帕奈在儿童难治性癫痫患者中的有效性、安全性与耐受性。方法回顾性分析2020年1月—2021年1月在苏州大学附属儿童医院就诊的34例难治性癫痫患儿的病历资料,通过对比患儿的基线情况与吡仑帕奈添加治疗后第4、8、12、24、36、48周的癫痫发作情况,来评估吡仑帕奈的疗效与不良反应。结果患儿添加吡仑帕奈治疗时的平均年龄为(8.1±4.1)岁,男女性别比为1∶1。吡仑帕奈添加治疗后,第4、8、12、24、36、48周的有效率分别为37.5%、46.7%、50.0%、47.4%、53.8%、42.9%,不良反应发生率为32.4%,药物保留率为88.2%。结论吡仑帕奈治疗难治性癫痫具有良好的有效性、安全性与耐受性。个性化治疗和较好的基线发作控制水平或许可以提高吡仑帕奈治疗的有效性和药物保留率。     

不同抗癫痫药物对新诊断癫痫患者一年保留率的回顾性研究

目的 比较几种一线抗癫痫药物单一治疗对新诊断癫痫患者的保留率.方法 我们利用门诊随访的方式,对284名新诊断癫痫患者首次使用单一抗癫痫药物治疗进行回顾性研究,采用多样本率的卡方分割法,对单一抗癫痫药的一年保留率进行分析.结果 最常见的一线抗癫痫药为丙戊酸钠(70例,24.6%),拉莫三嗪(59例,20.7%),卡马西平(56例,19.7%),奥卡西平(48例,16.9%),托吡酯(35例,12.3%).一年保留率依次为拉莫三嗪(93.2%),奥卡西平(72.9%),托吡酯(65.7%),卡马西平(62.5%),丙戊酸钠(65.7%).拉莫三嗪的一年保留率,与奥卡西平相比较,无统计学差异(P=0.08),与卡马西平(P=0.00089)、丙戊酸钠(P=0.00027)和托吡酯(P=0.018)相比,具有统计学差异.其他药物之间无明显统计学差异(P=0.315).结论 拉莫三嗪治疗新诊断癫痫患者的一年保留率最高.深入研究新诊断癫痫患者的首次抗癫痫药物保留率,将对我国癫痫患者的临床治疗提供更详细、准确的指导.     

CaBP4基因突变与小儿癫痫的关系

目的 探讨CaBP4基因突变与小儿癫痫的关系。方法 选取2016年3月-2018年3月在本院就诊的儿童癫痫60例,检测CaBP4基因突变分布,分析所有患儿相关的临床资料。结果 60例癫痫患儿中CaBP4基因p.G155D突变阳性患儿为31例,其突变率为51.67%; CaBP4基因未突变患儿29例,未突变率为49.33%。CaBP4基因突变与小儿癫痫的性别无明显关系(P>0.05)。CaBP4基因突变与癫痫患儿的首次发病年龄和月发作频率有关,即CaBP4基因p.G155D突变患儿的首次发病年龄低于CaBP4基因未突变患儿(P<0.05),CaBP4基因p.G155D突变患儿的月发作频率高于CaBP4基因未突变患儿(P<0.05)。CaBP4基因突变与小儿癫痫患儿的发作程度有关,即CaBP4基因p.G155D突变患儿重度癫痫发作的比例高于中度癫痫发作和轻度癫痫发作的比例(P<0.05)。CaBP4基因突变与小儿癫痫发作类型有关,即CaBP4基因p.G155D突变患儿局灶性发作的比例显著高于全面性发作和起源不明的比例(P<0.05)。CaBP4基因突变与癫痫患儿的首次发病年龄、月发作频率、发作程度、发作类型有关(P<0.05),而与癫痫患儿的性别无关(P>0.05)。结论 CaBP4基因p.G155D突变与癫痫患儿的首次发病年龄、月发作频率频率、发作程度、癫痫发作类型有关; 癫痫患儿CaBP4基因p.G155D突变率存在差异。     

改良的阿特金斯饮食治疗成人难治性癫痫的疗效观察

目的评估改良的阿特金斯饮食(MAD)治疗成人难治性癫痫的疗效。方法 19例成人难治性癫痫患者接受MAD治疗,随访1~15个月。记录发作频率及不良反应。结果 1个月有效率为63%,保留率100%;3个月有效率57%,保留率89%;6个月有效率为47%,保留率为47%。患者治疗前发作频率为4~152次/月,平均25次/月;治疗后1个月发作频率为0~100次/月,平均8次/月。住院期间患者β-羟丁酸(1.5±0.6)mmol/L,血糖(4.6±0.4)mmol/L;随访期间乙酰乙酸波动于~。与治疗前比较,治疗后第1个月和第3个月三酰甘油水平显著升高(均P0.05),但均值仍在正常范围;总胆固醇及低密度脂蛋白水平差异无统计学意义。不良反应表现为体质量减轻7例,高脂血症6例,乏力4例,便秘3例,腹泻2例,呕吐及肾结石1例。结论 MAD治疗成人难治性癫痫安全有效,没有手术指征的成人难治性癫痫患者排除禁忌后可选择MAD。     

Predictors and course of medically intractable epilepsy in young children presenting before 36 months of age: A retrospective, population-based study

Purpose: To determine the prevalence and identify predictors of medical intractability in children presenting with epilepsy before 36 months of age, and to assess the effect of medical intractability on long‐term mortality and intellectual function. Methods: Children with newly diagnosed epilepsy before 36 months between 1980 and 2009 while resident in Olmsted County, MN, were identified. Medical records were reviewed to collect epilepsy‐specific variables and long‐term outcome data. Medically intractable epilepsy was defined as either (1) seizure frequency greater than every 6 months at final follow‐up and failure of two or more antiepileptic drugs for lack of efficacy, or (2) having undergone epilepsy surgery after failure to respond to two or more antiepileptic drugs. Key Findings: One hundred twenty‐seven children with new‐onset epilepsy were identified and followed for a median of 78 months. Medically intractable seizures occurred in 35%, and significant predictors on multivariate analysis were age ≤12 months at diagnosis (odds ratio [OR] 6.76, 95% confidence interval [CI] 2.00, 22.84, p = 0.002), developmental delay at initial diagnosis of epilepsy (OR 20.03, 95% CI 3.49, 114.83, p = 0.0008), neuroimaging abnormality (OR 6.48, 95% CI 1.96, 21.40, p = 0.002), and focal slowing on initial EEG (OR 5.33, 95% CI 1.14, 24.88, p = 0.03). Medical intractability occurred early in the course in most children, being seen in 61% by 1 year, and 93% by 5 years after initial diagnosis. Mortality was higher (20% vs. 0%, p < 0.001) and intellectual outcome poorer (p < 0.001) if epilepsy was medically intractable. Significance: One third of children presenting with epilepsy before 36 months will be medically intractable, and significant predictors are identified. Medically intractable epilepsy is associated with increased mortality risk and significant intellectual disability.     

左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁患儿的疗效观察

目的 探讨左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁症儿童的临床疗效。方法 回顾性分析112例6~15岁癫痫伴抑郁症的临床资料,按年龄分为学龄组（6~12岁,56例）和少年组（13~15岁,56例）,评估治疗前后癫痫发作频率、认知功能（WISC-CR）、汉密尔顿抑郁量表17项（HAMD-17）、生活质量、身体质量指数（BMI）、不良反应发生率。结果 与治疗前相比,两组治疗6、12个月,癫痫发作频率、认知功能、HAMD-17评分、生活质量均显著改善（P<0.05）;同时,学龄组癫痫发作频率、认知功能、HAMD-17评分、生活质量均显著优于少年组（P<0.05）;两组治疗后BMI、不良反应发生率无统计学差异（P>0.05）。结论 采用左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁症儿童可获得显著的疗效,其中学龄组疗效优于少年组。     

Clinical analysis of catastrophic epilepsy in infancy and early childhood: Results of the Far-East Asia Catastrophic Epilepsy (FACE) study group

Purpose: We studied children younger than 6 years old who developed catastrophic epilepsy and were registered in the FACE study group to clarify their clinical characteristics and prevalence of seizure as well as epilepsy types. Subjects: Subjects were prospectively recruited from children with epilepsy who satisfied the following criteria and underwent intensive examination between 2009 and 2012 in 14 collaborative centers: (1) younger than 6 years old and (2) more than 10 seizures/month refractory to all available medical treatments including ACTH therapy, leading to significant psychosocial morbidity. Methods: We analyzed epilepsy onset age, predominant seizure type, etiology, neuropsychological findings, and syndromic classification according to the pre-determined registration format. Results: A total of 314 children were enrolled in this study. Epilepsy onset age in 239 cases (80%) was younger than 12 months. The most frequent seizure type was epileptic spasms (ES), followed by generalized tonic seizures (GTS), which accounted for 42% and 20%, respectively. West syndrome (WS) was the most frequent epileptic syndrome and accounted for 37%, followed by unclassified epilepsy at 21%, neocortical epilepsy at 19%, Lennox–Gastaut syndrome at 12%, Dravet syndrome at 4%, Rasmussen syndrome at 2%, and others. The two most frequent causes of epilepsy were cortical dysplasia and chromosomal anomalies, as shown in 16% and 6%, respectively. However, the etiology of nearly one half of all patients remained unknown. Psychomotor development was already worse than a moderate degree in 62% of subjects at the first examination. Conclusion: The highest proportion of catastrophic epilepsy was WS and its related syndromes featuring ES and GTS, followed by neocortical epilepsy, whose psychomotor development was significantly retarded at examinations.     

Withdrawal of antiepileptic drugs in adult patients free of seizures for 4 years: a prospective study

We aimed to assess the relapse rate of epilepsy, prospectively attributable to antiepileptic drug (AED) withdrawal in seizure-free patients and to determine the risk factors for seizure recurrence. Seventy-nine patients with epilepsy who were seizure-free for at least 4 years were enrolled into the study. The AEDs were tapered by one-sixth every 2 months. The EEG and clinical examination were performed at the beginning; at each visit during discontinuation and 2, 6, 12, 24, and 36 months after the complete drug withdrawal. For each patient, records were obtained of the main demographic and clinical variables. A total of 49 patients completed the discontinuation programme. Twenty-eight patients (57%) relapsed while 21 of those (42.8%) did not suffer a relapse at the end of the study period. In patients discontinuing treatment, the probability of relapse was 21.4% during the tapering period (especially in the last months), 28.6% at 1 month, 14.3% at 3 months, 3.6% at 6 months, 7.1% at 12 months, 17.8% at 24 months, and 7.1% at 36 months. The age at onset of epilepsy and the duration of active disease were found to affect the risk of relapse. Although drug withdrawal could be considered in adult patients free of seizures for 4 years, the final decision should be tailored to the patient's clinical, emotional, and socio-cultural profile.     

INFANTILE FEBRILE STATUS EPILEPTICUS: RISK FACTORS AND OUTCOME

The medical records of 68 children who had had infantile febrile status epilepticus (FSE) were examined. Follow-up periods ranged from three to 28 years (mean 8 years 10 months). Details were abstracted of relevant medical events prior to FSE, diagnosis of the febrile illness, age at onset and main characteristics of FSE, and outcome (subsequent febrile convulsions and/or epilepsy, neurological and psychiatric disorders). Neither medical events prior to FSE nor aetiology of fever were associated with subsequent febrile convulsions, epilepsy, or neurological or psychiatric abnormalities. There was a significant association between age at onset of FSE and both subsequent epilepsy and CNS disorders. 12 of the 13 children who had had transient or persistent post-ictal hemiparesis subsequently developed epilepsy. Of the 46 children who later developed epilepsy, 34 had partial seizures and 12 had generalized seizures. The latter were more common among children who had had FSE before the age of one year. Likewise, all those who developed severe myoclonic epilepsy in infancy had their first FSE before age one. These findings suggest that age at onset of FSE is the most important feature determining long-term outcome.     

Cognitive impairment in preschool children with epilepsy

Purpose: Studies have shown that underlying pathology and early onset of seizures are both significant factors contributing to cognitive impairment in children with epilepsy. However, there are only few studies focusing on cognitive impairment in preschool children with epilepsy. The purpose of this study was to describe the cognitive performance in a population‐based cohort of preschool children with epilepsy. The aims of the study were to determine frequency of cognitive impairment, level of cognitive functions, and epilepsy‐related factors correlating with cognitive impairment. Methods: The study group consisted of a population‐based cohort (N = 64) of preschool children (3–6 years 11 months) with active epilepsy. Medical data and results from previous psychological evaluations were reviewed retrospectively from the medical records. A logistic regression model was used for the prediction of cognitive impairment. Key Findings: Prevalence of epilepsy was 3.2 per 1,000 children. Cognitive function was considered to be within normal or borderline range for 50%, mildly retarded for 22%, and moderately to severely retarded for 28%. Cognitive impairment was related to complicated epilepsy, age at onset of epilepsy, abnormal magnetic resonance imaging (MRI), and additional neurologic problems. Age at the onset of seizures was the only significant predictor of cognitive impairment. Significance: The results concur with those of earlier studies on cognitive impairment in childhood epilepsy. Age at onset of epilepsy is also an important factor for cognitive impairment on young children with epilepsy. The results suggest that cognitive impairment is evident early in the course of epilepsy.     

Hand function and its prognostic factors of very low birth weight preterm children up to a corrected age of 24 months

A delay in functional hand performance broadly affects a child's successful participation in daily activities as well as later academic performance. Despite its high prevalence, hand function has received much less attention than other developmental domains, especially for young children. The aims of this study, therefore, were to examine hand function in preterm children up to a corrected age of 24 months; to establish predictive models for estimating preterm children's hand function; and to identify the contribution of early neuromotor assessments. This study included 230 preterm children (69, 76, and 85 children at corrected ages of 6-, 12-, and 24-months, respectively) who were recruited from the database of the preemie follow-up clinic at the National Cheng Kung University Hospital in Tainan, Taiwan. Hand function was evaluated using the Peabody Developmental Motor Scales II. Demographic information, birth history, and developmental documents were obtained from the medical records of routine preemie clinic follow-ups. Approximately half of healthy preterm children demonstrate hand function deficits at 12 and 24 months of corrected age. The Neonatal Medical Index, representing an infant's history of medical complication, was the best predictor of hand function at 12 and 24 months of corrected age. The social factor, represented by maternal educational year, was found to have influence on hand function only in preterm children at corrected age of 24 months old. Finally, early neuromotor performance demonstrated significant predictability of later hand function that supports the importance of continuous follow-up examinations in children with a history of prematurity. An understanding of a preterm child's early hand function as well as how its risk factors evolve helps clinicians both target children who might benefit from early intervention and ensure that children reach their full developmental potential.     

Differential effects of antiepileptic drugs on neonatal outcomes

Offspring of women with epilepsy (WWE) on AEDs are at increased risks for major congenital malformations and reduced cognition. They may be at risk for other adverse neonatal outcomes. Women with epilepsy on carbamazepine (CBZ), lamotrigine (LTG), phenytoin (PHT), or valproate (VPA) monotherapy were enrolled in a prospective, observational, multicenter study of the neurodevelopmental effects of AEDs. The odds ratio for small for gestational age (SGA) was higher for VPA vs. PHT, VPA vs. LTG, and CBZ vs. PHT. Microcephaly rates were elevated to 12% for all newborns and at 12 months old, but normalized by age 24 months. Reduced Apgar scores occurred more frequently in the VPA and PHT groups at 1 min, but scores were near normal in all groups at 5 min. This study demonstrates increased risks for being born SGA in the VPA and CBZ groups, and transiently reduced Apgar scores in the VPA and PHT groups. Differential risks among the AEDs can help inform decisions about AED selection for women during childbearing years.     

A predictive risk model for medical intractability in epilepsy

ObjectiveThis study aimed to investigate early predictors (6 months after diagnosis) of medical intractability in epilepsy.MethodsAll children < 12 years of age having two or more unprovoked seizures 24 h apart at Xinhua Hospital between 1992 and 2006 were included. Medical intractability was defined as failure, due to lack of seizure control, of more than 2 antiepileptic drugs at maximum tolerated doses, with an average of more than 1 seizure per month for 24 months and no more than 3 consecutive months of seizure freedom during this interval. Univariate and multivariate logistic regression models were performed to determine the risk factors for developing medical intractability. Receiver operating characteristic curve was applied to fit the best compounded predictive model.ResultsA total of 649 patients were identified, out of which 119 (18%) met the study definition of intractable epilepsy at 2 years after diagnosis, and the rate of intractable epilepsy in patients with idiopathic syndromes was 12%. Multivariate logistic regression analysis revealed that neurodevelopmental delay, symptomatic etiology, partial seizures, and more than 10 seizures before diagnosis were significant and independent risk factors for intractable epilepsy. The best model to predict medical intractability in epilepsy comprised neurological physical abnormality, age at onset of epilepsy under 1 year, more than 10 seizures before diagnosis, and partial epilepsy, and the area under receiver operating characteristic curve was 0.7797. This model also fitted best in patients with idiopathic syndromes.ConclusionA predictive model of medically intractable epilepsy composed of only four characteristics is established. This model is comparatively accurate and simple to apply clinically.     

Outcome of Epilepsy Surgery in the First Three Years of Life

PURPOSE: We analyzed our experience over a 6-year period with early-childhood patients who had undergone epilepsy surgery, and investigated the surgical outcomes. METHOD: We reviewed the medical records of 23 children, ages 0-3 years, who underwent epilepsy surgery between 1991 and 1996. RESULTS: Twenty children had partial seizures; two had infantile spasms; and one had generalized tonic-clonic seizures at onset. The mean age at onset of seizures was 4.7 months, and the mean age at time of surgery was 15.3 months. A total of 32 operations (21 focal cortical resections and 11 hemispherectomies) was performed. Five of 12 children with seizures secondary to a neuronal migration disorder had reoperations, including three who ultimately underwent complete hemispherectomy. The pathology consisted of hemimegalencephaly in three patients, focal cortical dysplasia (FCD) in eight, tuberous sclerosis in one, Sturge-Weber syndrome (SWS) in five, infarction in two, low-grade glioma (LGG) in three, and post-herpes simplex virus encephalitis (HSE) in one. The follow-up period ranged from 1 to 6.5 years (mean, 3.2 years) from patients' last operation. The seizure outcome according to Engel's criteria was class I in 12 patients, class II in three, class III in six and class IV in two. CONCLUSIONS: Seizure outcomes after surgery were less favorable in infants with FCD than in those with SWS and LGG. Seizure outcome for the patients with hemispherectomies was excellent, compared with those who had focal cortical resections.