Focal resection of epileptic tissue was performed in five infants under one year of age with malignant partial seizures and deteriorating developmental status at Miami Children’s Hospital and the Comprehensive Epilepsy Center, Miami, FL. Surgery was performed between two and 11 months of age. Pathology of resected specimens was as follows: Dysplastic gangliocytoma, hamartoma with tuberous sclerosis, gliosis and neuronal degeneration, and localized cortical gliosis. Remission of seizures was obtained in three of five infants and surgery did not result in significant neurologic deficit. [1]

COMMENT. The authors conclude that excisional surgery can be performed safely in selected infants with medically uncontrolled malignant partial seizures and may improve long-term seizure outcome. They emphasize referral to a center specializing in early childhood epilepsy surgery. The same authors report at the 42nd Annual Meeting of the AAN that intractable focal seizures in childhood have a histopathological spectrum distinct from that of adults. Malformations, particularly neuronal migration disorders are most frequent in infants whereas hippocampal sclerosis, a common pathology in adult epileptics, did not occur in the infants or the children in this report. (Neurology April 1990; 40 (Suppl I):187).