AUTHOR=Makridis Konstantin L. , Prager Christine , Tietze Anna , Atalay Deniz A. , Triller Sebastian , Elger Christian E. , Thomale Ulrich-Wilhelm , Kaindl Angela M. 

TITLE=Case Report: Hemispherotomy in the First Days of Life to Treat Drug-Resistant Lesional Epilepsy

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.818972

DOI=10.3389/fneur.2021.818972

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Neonatal drug-resistant epilepsy is often caused by perinatal epileptogenic insults such as stroke, ischemia, hemorrhage, and/or genetic defects. Rapid seizure control is particularly important for cognitive development. Since early surgical intervention and thus a short duration of epilepsy should lead to an optimal developmental outcome, we present our experience with hemispherotomy in an infant at the corrected age of 1 week.</p><p><bold>Methods:</bold> We report successful hemispherotomy for drug-resistant epilepsy in an infant with hemimegalencephaly at a corrected age of 1 week.</p><p><bold>Results:</bold> The infant was diagnosed with drug-resistant lesional epilepsy due to hemimegalencephaly affecting the left hemisphere. Given congruent electroclinical findings, we performed a left vertical parasagittal transventricular hemispherotomy after critical interdisciplinary discussion. No complications occurred during the surgery. Intraoperatively; 118 ml of red blood cells (30 ml/kg) and 80 ml of plasma were transfused. The patient has been seizure-free since discharge without further neurological deficits.</p><p><bold>Conclusion:</bold> We demonstrate that early epilepsy surgery is a safe procedure in very young infants if performed in a specialized center experienced with age-specific surgical conditions and perioperative management. The specific surgical difficulties should be weighed against the risk of life-long developmental drawbacks of ongoing detrimental epilepsy.</p>