Developmental outcome in infancy after epilepsy surgery and its associated factors: A systematic review and meta-analysis.

Objective: To investigate the impact of epilepsy surgery on the developmental outcome in infancy with pharmacoresistant epilepsy and its associated factors.

Method: This systematic review and meta-analysis was conducted in adherence with PRISMA 2020. Literature searching was done using PubMed, CENTRAL, and Scopus database. The risk of bias within included studies was evaluated using ROBINS-I. The developmental outcome was explored by comparing the developmental quotient (DQ) between before and after the epilepsy surgery. The subgroup analysis was planned for sex, etiology, affected side, affected lobe, surgical method and intention, and seizure-free state after the surgery. Age at onset of epilepsy, age at surgery, duration of disease, and follow-up time were explored as well in meta-regression.

Result: Ten articles were included in this review yielded 361 participants. The overall meta-analysis did not show a significant change of DQ after the surgery (MD -2.38; 95%CI -5.53 - 0.78). The comparison of delta DQ between seizure-free and not seizure-free population was not significantly different (seizure-free group; MD -4.33; 95%CI -20.37 - 11.70 vs. non-seizure-free group; MD -4.34; 95%CI -16.22 - 7.54). No independent significant moderator was identified.

Conclusion: Epilepsy surgery may offer some benefits in infants with PRE despite most participants having stable developmental progress. Seizure-free state following epilepsy surgery is crucial for infants' development; however, not all epileptogenic lesions are located in the favourable and resectable area. Hence, seizure control with palliative surgery shall be offered.