Surgery is being increasingly used to treat epilepsy in children. It's more risky than treatment with anti-epileptic drugs, but in carefully selected patients it has a very high success rate.

Children's brains are better able to re-grow and re-wire after surgery than adults'. The functions controlled by the area of the brain removed by the operation can be re-developed by other areas, so less overall functioning is lost. Doctors say children's brains are "more plastic". This means some radical types of surgery are possible in childhood that are not possible in adulthood: for example, removal of an entire half of the brain, called a hemispherectomy. In adults, this causes far too much damage to be beneficial, but in some types of childhood epilepsy it is a common and effective procedure.

In theory, the younger the child, the better able the brain is to reorganise itself after surgery. But how early? Dr Tobias Loddenkemper and colleagues at the Cleveland Clinic in Ohio, USA, analysed data from 24 children aged less than three years at the time of their operation. They specifically looked at the effect surgery had on the child's level of development (thinking, learning and social skills; you could also call this mental age) in addition to the effect on seizure frequency. Their study was published in May in the journal Pediatrics.

Fourteen of the children in the study had a hemispherectomy, and ten had a smaller section removed. More than half (17 out of the 24 children) became seizure-free after surgery; all but one of the others had a greater than 50% drop in seizure frequency.

The researchers evaluated the children's development and cognition levels both before after surgery, using a tool called the Bayley Scales of Infant Development. They found higher developmental levels in most patients after their operation. The biggest improvements were seen in those children who were operated on when younger. Children with a syndrome called infantile spasms responded especially well to surgery.

While these results are interesting and encouraging, it will be interesting to see whether they are borne out by bigger studies on larger numbers of children, and with longer follow-up, since the type of epilepsy the child has appears to make a difference. It would also be very interesting to see whether the treatment of infants with anti-epileptic drugs, rather than surgery, can produce similar improvements in development.

Epilepsy Research UK is currently funding a survey of the
different types of epilepsy seen in infants, which may help answer these questions. This work includes assessing the developmental status of infants at diagnosis, with the tests repeated at regular intervals after that to follow the effects of further seizures and their treatment.

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