Epilepsy surgery in the first six months of life: A systematic review and meta-analysis.

Autor: Makridis KL; Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; Center for Chronically Sick Children, Augustenburger Platz 1, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Cell- and Neurobiology, Charitéplatz 1, Berlin 10117, Germany., Atalay DA; Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; Center for Chronically Sick Children, Augustenburger Platz 1, Berlin, Germany., Thomale UW; Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany., Tietze A; Charité - Universitätsmedizin Berlin, Institute of Neuroradiology, Augustenburger Platz 1, Berlin 13353, Germany., Elger CE; Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; Center for Chronically Sick Children, Augustenburger Platz 1, Berlin, Germany; Beta Neurologie - Kompetenzzentrum für Epilepsie, Beta Klinik GmbH, Joseph-Schumpeter-Allee 15, Bonn 53227, Germany., Kaindl AM; Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; Center for Chronically Sick Children, Augustenburger Platz 1, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Cell- and Neurobiology, Charitéplatz 1, Berlin 10117, Germany. Electronic address: angela.kaindl@charite.de.
Jazyk: angličtina
Zdroj: Seizure [Seizure] 2022 Mar; Vol. 96, pp. 109-117. Date of Electronic Publication: 2022 Feb 17.
DOI: 10.1016/j.seizure.2022.02.009
Abstrakt: Introduction: Nearly one-third of all infants with epilepsy develop drug-resistant epilepsy. Although epilepsy surgery is a well-established therapy across all age groups, there might be a reluctance to operate on infants in the first six months of life due to unique surgical and anesthesiologic difficulties.
Methods: We performed a meta-analysis and systematic review to assess the outcome and complication rate of epilepsy surgery in infants operated on ≤ six months of life.
Results: 158 infants underwent epilepsy surgery, most frequently a hemispherotomy rather than focal surgery. Overall seizure freedom after surgery was 65.6% [CI: 0.5785; 0.7261], with higher seizure-free rates following hemispherotomy (71%) than after focal surgery (58%). Complications occurred in 27.7% [0.1794; 0.4004] of patients. Most prevalently, a hydrocephalus developed in 20 out of 136 cases (14.71%). Anti-seizure medication (ASM) was discontinued in 21.5% [0.1431; 0.3100] and reduced in 85.9% [0.515; 0.9721] of 93 patients postoperatively. 84.6% of infants displayed cognitive impairment (development quotient (DQ) <85) preoperatively. After surgery, there was a trend toward a cognitive gain. However, cognitive gain was seen almost exclusively in seizure-free patients.
Discussion: Excellent seizure control can be achieved with epilepsy surgery in the first six months of life, a large proportion of patients are able to reduce or discontinue ASM. Data regarding cognitive outcome are promising, but also show that the primary goal should be to achieve seizure freedom. Given the more difficult surgical conditions, epilepsy surgery in the first six months of life should only be performed in specialized epilepsy centers.
(Copyright © 2022 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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