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Abstract：
Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on \"ultra-early\" epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study\'s goal is to review the safety and efficacy of ultra-early epilepsy surgery performed before the age of 3 months.
To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications.
Sixty-four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41 months (19-104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1-3 IQR, p < .0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections).
Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.
To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications.
Sixty-four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41 months (19-104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1-3 IQR, p < .0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections).
Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.
摘要：
耐药性癫痫（DRE）在生命的头几个月是具有挑战性的，需要积极的治疗，包括手术。因为婴儿期DRE的最常见原因与广泛的发育异常有关，手术通常需要广泛的组织切除或断开。关于“超早期”癫痫手术的文献很少，关于控制癫痫发作的功效的数据有限，和安全。本研究的目的是回顾3月龄前进行超早期癫痫手术的安全性和有效性。
为了实现大样本量和外部有效性，一个跨国公司，进行了多中心回顾性研究，3个月以下婴儿的癫痫手术。收集的数据包括癫痫特征，手术细节,癫痫结果,和并发症。
64例患者在3个月大之前接受了69例手术。最常见的病理是皮质发育不良（28），半脑畸形（17），块茎（5）。最常见的手术是半球手术（48个手术）。两起案件是故意上演的，一个意外流产。几乎所有患者都接受了血液制品。没有围手术期死亡，也没有重大的意外永久性疾病。接受半球手术的患者中有25％出现脑积水。在41个月的中位随访时间（19-104四分位距[IQR]）中，66％的病例获得了出色的癫痫结局（国际抗癫痫联盟[ILAE]I级）。抗癫痫药物的数量显着减少（中位数为2种药物，1-3IQR,p<.0001)。结果与手术类型（半球或更有限的切除）没有显着相关。
生命最初几个月的癫痫手术与良好的癫痫发作控制有关，当由经验丰富的团队表演时，在年龄较大的婴儿中，与手术相比，与永久性发病率无关。因此，不应根据年龄推迟手术治疗以治疗非常小的婴儿的DRE。
为了实现大样本量和外部有效性，一个跨国公司，进行了多中心回顾性研究，3个月以下婴儿的癫痫手术。收集的数据包括癫痫特征，手术细节,癫痫结果,和并发症。
64例患者在3个月大之前接受了69例手术。最常见的病理是皮质发育不良（28），半脑畸形（17），块茎（5）。最常见的手术是半球手术（48个手术）。两起案件是故意上演的，一个意外流产。几乎所有患者都接受了血液制品。没有围手术期死亡，也没有重大的意外永久性疾病。接受半球手术的患者中有25％出现脑积水。在41个月的中位随访时间（19-104四分位距[IQR]）中，66％的病例获得了出色的癫痫结局（国际抗癫痫联盟[ILAE]I级）。抗癫痫药物的数量显着减少（中位数为2种药物，1-3IQR,p<.0001)。结果与手术类型（半球或更有限的切除）没有显着相关。
生命最初几个月的癫痫手术与良好的癫痫发作控制有关，当由经验丰富的团队表演时，在年龄较大的婴儿中，与手术相比，与永久性发病率无关。因此，不应根据年龄推迟手术治疗以治疗非常小的婴儿的DRE。
