Objective:

n/a

Background:

Epilepsy surgery offers opportunity for seizure remission in patients with focal epilepsy refractory to polytherapy. Traditionally, only small portion of patients with drug resistant epilepsy are referred for surgical consideration. The patients who are referred on average have had epilepsy for two decades or more, leading to seizure related complications. We present our case report of an infant with severe refractory epilepsy, who underwent right temporal neocortical resection for focal cortical dysplasia at day 21 of life

Design/Methods:

Baby born at 38 weeks, on day of life 3 had apneic events associated with movements of her mouth and eye deviation to left. On EEG monitoring showed focal motor seizures originating from right temporal region. MRI Head revealed area of cortical dysplasia in the right middle and inferior temporal gyrus. The seizures were initially controlled but had breakthrough seizures on polytherapy requiring readmission. Risk of ongoing seizures with potential risks of surgery at young age were reviewed by our multidisciplinary team. As resection of the lesion would be curative, parents agreed for the procedure. Patient had the surgery: right sided hippocampal sparing temporal neocortical resection on Day of life 21. Patient was monitored post procedure, there were no seizures, so patient was able to be weaned off phenobarbital and phenytoin. Patient had repeat EEG 3 weeks post procedure for facial twitching and they were not epileptic. In the past year, patient was able to be weaned to Topiramate monotherapy with no further seizures and normal development for age.

Results:

n/a

Conclusions:

We present this case to highlight the use of surgical resection in infants with refractory focal seizures, even within the first month of life. Our patient has had a seizure free first year of life, is now on monotherapy, and her development is normal.