Brain Surgery In Babies Can Reduce Seizures

What was studied

This study looked at hemispheric surgery in infants with early drug-resistant epilepsy caused by hemimegalencephaly (HME) or hemispheric cortical dysplasia (HCD). All were younger than 12 months old when they had surgery at one national epilepsy surgery referral center.

The researchers reviewed past records from 2005 to 2024. They included 15 infants total: 13 with HME and 2 with HCD. They examined seizure onset, age and weight at surgery, blood product requirements, time on a breathing machine, intensive care stay, complications, and seizure outcomes by Engel classification.

What they found

Seizures started very early, with a median age of 3 days, and all infants had multiple daily seizures. Surgery happened at a median age of 6.4 months. These operations were intensive: every infant needed blood transfusion during surgery, and 5 of 15 needed more than one circulating volume replaced.

There were no deaths. Major complications included bleeding inside the brain in 2 of 15 infants and cardiac arrest during surgery in 1 of 15. Other frequent adverse events were a postoperative intensive care stay of more than 5 days in 6 of 15 infants and later shunt placement for hydrocephalus in 4 of 15.

At 12 months after surgery, 8 of 15 infants had an Engel class I outcome. Among the 13 infants with HME, 6 had an Engel class I outcome. The authors concluded that surgery in the first year of life is feasible but demanding, with substantial perioperative risk, and that multidisciplinary management remains important.

Limits of the evidence

This was a small retrospective study from a single center, so the results may not apply everywhere. There was no comparison group of similar infants who did not have surgery or who had surgery at a different age.

The study included two conditions together, but most infants had HME, so the results for HCD are especially uncertain. Follow-up reported in the abstract was at 12 months, so the abstract does not show longer-term seizure outcomes, development, or quality of life.

For families and caregivers

For families, this study suggests that hemispheric surgery in the first year of life may lead to an Engel class I seizure outcome for some infants with very severe epilepsy caused by HME or HCD. But it also shows that the surgery is major, often needs large blood transfusions, and can have serious complications.

This may help families understand both sides of the decision: there may be a meaningful chance of a very good seizure outcome, but the operation and recovery can be difficult. The findings also highlight the importance of multidisciplinary care.

What to watch next

Larger multicenter studies with longer follow-up could help clarify seizure outcomes, development, and complications over time, especially for infants with HCD.

Terms in this summary

drug-resistant epilepsy

Epilepsy that does not come under good control after trying appropriate seizure medicines.

hemimegalencephaly

A brain development condition where one half of the brain is abnormally large and often causes severe seizures.

hemispheric cortical dysplasia

A brain development problem affecting the outer layer of one side of the brain.

functional hemispherectomy

An operation that disconnects most of one half of the brain from the rest so seizures are less able to spread.

hemispherotomy

A surgery that mainly disconnects one half of the brain rather than removing large amounts of brain tissue.

hydrocephalus

A buildup of fluid in or around the brain.

shunt

A tube placed by surgery to drain extra fluid from the brain to another part of the body.

Engel class I

A seizure outcome rating used after epilepsy surgery; in this study it was the reported seizure outcome category at 12 months.