The medical records of 23 children, ages 0-3 years, who were treated surgically for epilepsy between 1991 and 1996 were analysed at the Hospital for Sick Children, Toronto, Canada. The mean age at onset of seizures was 4.7 months, and the mean age at time of surgery was 15.3 months. Partial seizures were diagnosed at onset in 20, infantile spasms in 2, and generalized tonic-clonic seizures in one. Focal cortical resection was performed in 21 and hemispherectomy in 11. Pathological findings included focal cortical dysplasia (8 patients), Sturge-Weber syndrome (5), hemimegalencephaly (3), low-grade glioma (3), and tuberous sclerosis (1). Seizure outcome was class I in 12, class II in 3, class III in 6, and class IV in 2 (Engel’s criteria). Outcomes for Sturge-Weber and low-grade glioma patients were better than those with neuronal migration disorders (NMD). Patients with NMD who did poorly had normal MRI/CT findings at seizure onset, a diffuse irritative zone on EEG, and extensive focal cortical resections affecting multiple lobes. Patients having hemispherectomies did better than those with focal cortical resections. 
COMMENT. Young children with refractory epilepsy may benefit from surgery, especially in those showing concordance of ictal video-EEG and neuroimaging data. The outcome in children undergoing hemispherectomy is superior to results of focal cortical resection.