Epilepsy surgery in children operated on before 3 years of age – experience of the Motol epilepsy center
Authors:
M. Ebel 1; A. Maulisová 2,3; M. Kudr 1; A. Jahodová 1; A. Bělohlávková 1; B. Splítková 1; K. Bukačová 2; R. Janča 4; M. Kynčl 5; Z. Holubová 5; M. Mamiňák 1; G. A. R. Rivera 6; V. Novák 7; M. Koblížek 8; M. Tichý 9; P. Libý 9; P. Kršek 1
Authors‘ workplace:
Klinika dětské neurologie 2. LF UK a FNMH, Praha
1; Oddělení klinické psychologie, FNMH, Praha
2; Katedra psychologie FF UK, Praha
3; Katedra teorie obvodů, Fakulta elektrotechnická ČVUT, Praha
4; Klinika zobrazovacích metod 2. LF UK FNMH, Praha
5; Oddělení neurologie, Nemocnica Bory v Bratislave, Slovensko
6; Oddělení dětské neurologie, FN Ostrava
7; Ústav patologie a molekulární medicíny 2. LF UK a FNMH, Praha
8; Neurochirurgická klinika dětí a dospělých 2. LF UK a FNMH, Praha
9
Published in:
Cesk Slov Neurol N 2026; 89(3): 162-169
Category:
Original Paper
doi:
https://doi.org/10.48095/cccsnn2026162
Overview
Aim: The aim of this study was to comprehensively evaluate clinical characteristics, surgical strategies, and outcomes of epilepsy surgery in children with focal structural epilepsy operated on before 3 years of age at the Motol Epilepsy Center, and to identify factors associated with postoperative seizure control and neurodevelopmental outcomes. Methods: A retrospective analysis was performed on a cohort of children who underwent resective or disconnective epilepsy surgery before three years of age between 2000 and 2025. Clinical and electroencephalographic characteristics, neuroimaging findings, type and extent of surgery, histopathological diagnosis, postoperative complications, and long-term seizure outcomes were assessed. Postoperative seizure control was evaluated using the Engel and International League Against Epilepsy (ILAE) classifications. Neurodevelopment was assessed using developmental or intelligence quotient measures before and after surgery. Statistical analysis included non-parametric tests and correlation analyses. Results: A total of 77 surgical procedures were performed in 66 children. The median age at surgery was 22 months. The most common etiologies were malformations of cortical development and tuberous sclerosis complex. Earlier epilepsy onset was observed in patients with a more extensive epileptogenic zone. Long-term seizure freedom (≥ 2 years) was achieved in 77% of patients, of whom 70% were able to discontinue antiseizure medication completely. A longer interval between epilepsy onset and surgery and older age at surgery were associated with poorer postoperative outcomes. Permanent neurological deficits were rare. Lower preoperative developmental quotient was associated with earlier epilepsy onset and a larger epileptogenic zone. Cognitive performance and the prevalence of associated neurodevelopmental disorders remained stable after surgery. Conclusion: Epilepsy surgery in children operated on before three years of age is an effective treatment with a high likelihood of achieving seizure freedom and the potential for complete withdrawal of antiseizure medication. Early surgical indication is a key determinant of favorable outcomes and may contribute to stabilization of the neurodevelopmental profile in this high-risk patient population.
Keywords:
epilepsy surgery – Quality of life – complications – drug-resistant epilepsy – presurgical evaluation – seizure control – cognitive outcomes
Sources
1. Stevering CH, Lamberink HJ, Woodfield J et al. Cumulative effects of antiseizure medication on intelligence in children with focal epilepsy. Epileptic Disord 2022; 24 (5): 877–888. doi: 10.1684/epd.2022.1467.
2. Thurman DJ, Hesdorffer DC, French JA. Sudden unexpected death in epilepsy: assessing the public health burden. Epilepsia 2014; 55 (10): 1479–1485. doi: 10.1111/epi.12666.
3. Lu R, Wang M, Zhang Y et al. Safety, accuracy, and efficacy of robot-assisted stereo electroencephalography in children of different ages. Neurosurgery 2024; 95 (1): 137–145. doi: 10.1227/neu.0000000000002853.
4. Roth J, Constantini S, Ekstein M et al. Epilepsy surgery in infants up to 3 months of age: safety, feasibility, and outcomes: a multicenter, multinational study. Epilepsia 2021; 62 (8): 1897–1906. doi: 10.1111/epi.16959.
5. Lamberink HJ, Otte WM, Blümcke I et al. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurol 2020; 19 (9): 748–757. doi: 10.1016/S1474-4422 (20) 30220-9.
6. Sanders MWCB, Ebel M, Chari A et al. What determines the timing of epilepsy surgery in children with cortical malformations and low-grade epilepsy-associated tumors?. Epilepsia Open 2025; 10 (5): 1345–1352. doi: 10.1002/epi4.70074.
7. Beniczky S, Trinka E, Wirrell E et al. Updated classification of epileptic seizures: position paper of the international league against epilepsy. Epilepsia 2025; 66 (6): 1804–1823. doi: 10.1111/epi.18338.
8. Pressler RM, Cilio MR, Mizrahi EM et al. The ILAE classification of seizures and the epilepsies: modification for seizures in the neonate. position paper by the ILAE task force on neonatal seizures. Epilepsia 2021; 62 (3): 615–628. doi: 10.1111/epi.16815.
9. Bjellvi J, Flink R, Rydenhag B et al. Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study. JNS 2015; 122 (3): 519–525. doi: 10.3171/2014.9.JNS132679.
10. Gaser C, Dahnke R, Thompson PM et al. The Alzheimer’s Disease Neuroimaging Initiative. CAT: a computational anatomy toolbox for the analysis of structural MRI data. GigaScience 2024; 13: giae049. doi: 10.1093/gigascience/giae049.
11. Engel J. Update on surgical treatment of the epilepsies. summary of the second international palm desert conference on the surgical treatment of the epilepsies (1992). Neurology 1993; 43 (8): 1612–1617. doi: 10.1212/wnl.43.8.1612.
12. Wieser HG, Blume WT, Fish D et al. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia 2001; 42 (2): 282–286.
13. Bělohlávková A, Jezdik P, Jahodova A et al. Evolution of pediatric epilepsy surgery program over 2000–2017: Improvement of care? Eur J Paediatr Neurol 2019; 23 (3): 456–465. doi: 10.1016/j.ejpn.2019.04.002.
14. Kadish NE, Bast T, Reuner G et al. Epilepsy surgery in the first 3 years of life: predictors of seizure freedom and cognitive development. Neurosurgery 2019; 84 (6): E368–E377. doi: 10.1093/neuros/nyy376.
Labels
Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
2026 Issue 3
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