Few studies have examined the impact of epilepsy surgery on patients younger than 3 years old, lead author Dr Tobias Loddenkemper, from the Cleveland Clinic, and colleagues note in the journal Pediatrics.

Although surgery is the treatment of choice for seizures that don't respond to drugs, deciding when to operate can be difficult, according to the report. Early surgery might improve developmental outcomes, yet it may also be an unnecessary risk if the seizures later become responsive to drug treatment.

The present study involved 50 infants who underwent epilepsy surgery and later were evaluated using the Bayley Scales of Infant Development. From each Bayley score, a development quotient was derived to allow comparison of children at different ages.

Of the 24 infants with complete data, the majority - 17 - became seizure-free after surgery and 5 more experienced greater than 90 percent reduction in seizures. One patient experienced a greater than 50 percent seizure reduction and one had no change.

Surgery was associated with improvements in development. The developmental status before surgery was a predictor of developmental function after surgery.

The biggest improvements in development were noted in infants treated at younger ages and in those with epileptic spasms.

The investigators believe that this is the first study to use formal neurodevelop-mental testing before and after surgery in infants under 36 months old at the time of epilepsy surgery, the investigators note.

Source: Pediatrics, May, 2007