Up to one-tenth of the lifetime risk of epilepsy is realized in the first 3 years of life. Early-onset epilepsies might be associated with severe lifelong disability.  In 30% of children medical treatment is unsatisfactory; surgery may be considered as an option. The purpose of this study was to provide seizure outcome of infants and toddlers who underwent surgical treatment for epilepsy, considering risks of the procedures.

Retrospective data on 33 patients younger than age 3 years who underwent epilepsy surgery between 1996 and 2013, with at least one year follow up, were collected. Postoperatively, Engel classification was used for seizure short and long term outcomes.

Ages between 2 and 36 months (mean 19.3), 18 males (48.6%). Mean follow-up was 6.1 years (1 to 16.8). Etiologies: malformation of cortical development 16 (48.5%), acquired causes 7 (21.2%), progressive disease 10 (30.3%). Twenty patients (60.6%) underwent hemispherotomy, 4 (12.1%) lesionectomy, 5 (15.2%) lobectomy and 4 (12.1%) VNS. At last clinical evaluation, 16 patients (50%) were Engel I, 3 (​​9.4%) Engel II, 9 (28.1%) Engel III and 4 (12.5%) Engel IV. Postoperative complications: mild motor deficit 6 (18%), treatable infection 6 (18.1%), intracranial hypertension 2 (6.1%), bleeding 2 (6.1%), liquoric fistula 1 (3%). There was one surgical mortality (3%).  

Epilepsy surgery in infants and toddlers is effective for seizure control and can be performed with acceptable morbidity and mortality. Surgical intervention should be considered even in infants if seizures are poorly controlled.