Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 930-935 (doi:10.1542/10.1542/peds.2006-2530)
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ARTICLE

Developmental Outcome After Epilepsy Surgery in Infancy

Tobias Loddenkemper, MDa, Katherine D. Holland, MD, PhDb, Lisa D. Stanford, PhDc, Prakash Kotagal, MDa, William Bingaman, MDd and Elaine Wyllie, MDa

a Departments of Pediatric Neurology
d Pediatric Neurosurgery, Cleveland Clinic, Cleveland, Ohio
b Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
c Department of Psychiatry, University of Illinois College of Medicine, Chicago, Illinois

OBJECTIVES. Our goals were to determine the effect of epilepsy surgery in infants (<3 years of age) on development and describe factors associated with postoperative developmental outcome.

METHODS. We identified 50 infants among 251 consecutive pediatric patients (<18 years old) undergoing epilepsy surgery. Charts were reviewed for clinical data and neurodevelopmental testing with the Bayley Scales of Infant Development. A developmental quotient was calculated to compare scores of children at different ages.

RESULTS. Complete data were available on 24 of 50 infants. Surgeries included 14 hemispherectomies and 10 focal resections. Seventeen patients became seizure free; 5 patients had >90% seizure reduction, 1 had >50% seizure reduction, and 1 had no change. The developmental quotient indicated modest postoperative improvement of mental age. The preoperative and postoperative development quotients correlated well. Younger infants had a higher increase in developmental quotient after surgery. Patients with epileptic spasms were younger and had a lower developmental quotient at presentation, but increase in developmental quotient was higher in this subgroup.

CONCLUSIONS. After surgery, seizure frequency and developmental quotient improved. Developmental status before surgery predicted developmental function after surgery. Patients who were operated on at younger age and with epileptic spasms showed the largest increase in developmental quotient after surgery.

Key Words: epilepsy surgery • infants • development

Abbreviations: AED— antiepileptic drug • MCD—malformation of cortical development • DQ—developmental quotient

Accepted Jan 11, 2007.


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