The aim of this study was to evaluate the yield of electroencephalography and structural and functional neuroimaging in children having resective epilepsy surgery before 5 years of age. Charts of all 28 children (54% male) having resective surgery before 60 months of age at the Mayo Clinic between January 2002 and June 2009 were reviewed. Mean age at seizure onset was 9.6 months (S.D. 12.7); mean age at surgery was 28.8 months (S.D. 17.7). Sixteen children (57%) had partial-onset seizures, 8 (29%) had partial-onset seizures and spasms, and 4 (14%) had spasms alone. Initial surgery type was hemispherectomy in 6 cases, multilobar resection in 8, temporal in 7, and extratemporal in 7. Only 10 of the 25 children (40%) with recorded seizures preoperatively had a well-localized, single ictal focus. Ictal discharge was generalized in 8/25 cases (32%), both generalized and focal in 1 case (4%), hemispheric in 4 cases (16%), and absent in 1 case (4%). Findings from magnetic resonance imaging were abnormal in 27 cases, and revealed focal pathology in 20. Surgical outcome was favorable, with 18 of the 27 survivors (67%) being free, or nearly free, of disabling seizures. In summary, electroencephalography frequently failed to indicate a single ictal focus in young children having epilepsy surgery. In contrast, magnetic resonance imaging was more helpful, revealing focal abnormalities in 74% of patients.
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