Two-year postsurgical developmental outcome was assessed in 24 children with infantile spasms treated at the University of California, Los Angeles. All were symptomatic cases with neurological deficits and had received ACTH and multiple medications without benefit before the cortical resections. Seizures began at a mean age of 12 weeks and surgery was at 20 months of age. The developmental levels assessed by the Vineland Adaptive Behavior Scales were significantly increased at 2 years post surgery compared to presurgical levels, and only one child was severely retarded. The outcomes in this UCLA surgical series were equal to and sometimes superior to other symptomatic series receiving only medical treatment. Those who received surgery at an early age had the better presurgical developmental levels and the best 2-year postsurgery outcomes. [1]
COMMENT. Developmental outcome in children undergoing cortical resection for infantile spasms is correlated with presurgical developmental levels and the time exposed to uncontrolled seizures. The earlier the surgery, the shorter the exposure to adverse effects of seizures on cognitive functioning. Candidates for surgery have focal or lateralized pathology, a factor that might contribute to the better than average developmental outcomes in the above series. Nonetheless, resective surgery appears to result in improved outcomes for children with ACTH-refractory infantile spasms.