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<p>Epilepsy surgery in early childhood represents a&#xa0;time-critical intervention for selected children with drug-resistant epilepsy, in whom ongoing epileptic activity may disrupt neuronal networks and brain development. In this age group, surgical decision-making differs from that in older children and adults, as indications, risks, and outcomes are closely intertwined with neurodevelopmental vulnerability and plasticity. This narrative review provides a&#xa0;clinically oriented overview of epilepsy surgery in children aged 3&#xa0;years and younger. We discuss age-specific considerations regarding drug resistance, etiological spectrum, presurgical evaluation, and surgical strategies, with particular emphasis on the rationale for early intervention. Available data indicate that epilepsy surgery in early childhood can achieve durable seizure control in a&#xa0;substantial proportion of carefully selected patients, particularly when performed in specialized centers. Surgery may stabilize rather than reverse developmental impairment. Persistent seizures, widespread or evolving epileptogenic networks, and diffuse underlying pathological changes remain key determinants of suboptimal outcome. Ethical considerations and shared decision-making are integral to early epilepsy surgery, requiring transparent communication of findings, options, risks, and uncertainty as well as a&#xa0;careful balancing of irreversible surgical effects against the ongoing harm of uncontrolled epilepsy. Early referral and individualized, multidisciplinary evaluation are essential to optimize outcomes in this vulnerable population.</p>

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Epilepsy surgery in early infancy—an overview

  • 期刊论文

  • 发表日期：

    2026年6月18日

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  • Ingo Borggraefe,
  • Malin Zaddach,
  • Leonie Nicolai,
  • Mathias Kunz,
  • Christian Vollmar

摘要

Epilepsy surgery in early childhood represents a time-critical intervention for selected children with drug-resistant epilepsy, in whom ongoing epileptic activity may disrupt neuronal networks and brain development. In this age group, surgical decision-making differs from that in older children and adults, as indications, risks, and outcomes are closely intertwined with neurodevelopmental vulnerability and plasticity. This narrative review provides a clinically oriented overview of epilepsy surgery in children aged 3 years and younger. We discuss age-specific considerations regarding drug resistance, etiological spectrum, presurgical evaluation, and surgical strategies, with particular emphasis on the rationale for early intervention. Available data indicate that epilepsy surgery in early childhood can achieve durable seizure control in a substantial proportion of carefully selected patients, particularly when performed in specialized centers. Surgery may stabilize rather than reverse developmental impairment. Persistent seizures, widespread or evolving epileptogenic networks, and diffuse underlying pathological changes remain key determinants of suboptimal outcome. Ethical considerations and shared decision-making are integral to early epilepsy surgery, requiring transparent communication of findings, options, risks, and uncertainty as well as a careful balancing of irreversible surgical effects against the ongoing harm of uncontrolled epilepsy. Early referral and individualized, multidisciplinary evaluation are essential to optimize outcomes in this vulnerable population.