Case Report: Early surgical intervention for epilepsy with mild MOGHE: timing and clinical efficacy

Background: Mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE) is a new histopathological entity identified in resected brain tissue from patients with drug-resistant epilepsy. Clinically, this epilepsy subtype most commonly presents as epileptic spasms in early childhood. Conventional anatomical-electro-clinical approaches struggle to accurately delineate the epileptogenic zone, posing substantial challenges to clinical management. Case description: This paper reports a 2-year-and-11-month-old male infant who developed significant intellectual and language regression merely 3 months after the onset of epileptic seizures. Scalp video-electroencephalography (VEEG) demonstrated generalized epileptiform discharges, cranial magnetic resonance imaging (MRI) revealed abnormal signals in the left frontal lobe, and fused cranial 18F-fluorodeoxyglucose positron emission tomography (PET)-MRI imaging showed no obvious hypometabolic foci. Following oral vigabatrin administration, clinical seizures were absent, yet neurodevelopmental regression progressed continuously. For children with early-onset developmental regression, a clinical decision-making dilemma exists: whether to continue medication adjustment and await fulfillment of traditional drug-resistant epilepsy criteria before surgery, or to implement active early surgical intervention. Conclusion: Through full-course follow-up of this child with MOGHE-associated epilepsy, this study integrated the evolution of clinical symptoms, electroencephalographic characteristics, imaging findings, and treatment responses to explore the rationale for surgical timing selection. The results suggest that for childhood epilepsy caused by definite cerebral structural abnormalities (particularly MOGHE) that has already led to obvious neurodevelopmental regression, active early surgical treatment should be considered to prevent disease progression and create favorable conditions for subsequent rehabilitation.