The impact of early life epilepsy on long term neurological development: a comprehensive study of pediatric patients

Background: Early-onset epilepsy disrupts brain development during critical childhood periods, impacting cognitive, motor, and behavioural functions. Objectives: This study aimed to evaluate the long-term effects of early-life epilepsy on paediatric neurological development and compare outcomes across pharmacological therapy, surgical interventions, and alternative therapies (e.g., ketogenic diets, neurostimulation). Methods: A prospective observational study was conducted at different teaching hospitals of Lahore, Pakistan from October 2022 to October 2023. A total of 150 children (aged 0–5 years) with diagnosed epilepsy were enrolled. Patients were categorized into three groups: pharmacological therapy (n=70), surgical intervention (n=40), and alternative therapies (n=40). Standardized tools assessed cognitive (WPPSI), motor (PDMS-2), and behavioural outcomes (CBCL, SRS), along with seizure control and treatment side effects. Results: Surgical intervention demonstrated the best outcomes, with significant improvements in IQ (92.7 ± 8.9), motor skills (fine: 89.2 ± 9.5, gross: 88.0 ± 9.7), and social interaction (90.4 ± 8.5). Seizure freedom was achieved in 75% of surgical cases compared to 21.4% in pharmacological therapy and 45% in alternative therapies. Behavioural issues and side effects, such as attention deficits (40%) and drowsiness (50%), were most prevalent in the pharmacological group. Conclusion: Surgical interventions significantly improved developmental outcomes and seizure control in drug-resistant epilepsy cases. Early diagnosis and personalized, targeted treatments are essential to mitigate the neurodevelopmental impact and enhance the quality of life for affected children.