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Fernández-Concepción O, López Jiménez M, Valencia-Calderón C, Calderón-Valdivieso A, Recasén-Linares A, Reyes-Haro L, Vásquez-Ham C. Safety and effectiveness of surgery for epilepsy in children. Experience of a tertiary hospital in Ecuador. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Fernández-Concepción O, López Jiménez M, Valencia-Calderón C, Calderón-Valdivieso A, Recasén-Linares A, Reyes-Haro L, Vásquez-Ham C. Safety and effectiveness of surgery for epilepsy in children. Experience of a tertiary hospital in Ecuador. Neurologia 2018. [PMID: 29525400 DOI: 10.1016/j.nrl.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION There is sufficient evidence on the usefulness of surgery as a therapeutic alternative for patients with drug-resistant epilepsy; however this treatment is underutilized, especially in developing countries. METHODS We describe the outcomes of epilepsy surgery in 27 paediatric patients at Hospital Baca Ortiz in Quito, Ecuador. Our analysis considered the following variables: reduction in seizure frequency, surgery outcome according to the Engel classification, improvement in quality of life, and serious complications due to surgery. RESULTS 21 corpus callosotomies and 6 resective surgeries were performed. The mean seizure frequency decreased from 465 per month before surgery to 37.2 per month thereafter (p<.001); quality of life scale scores increased from 12.6 to 37.2 (p<.001), and quality of life improved in 72.7% of patients. Regarding resective surgery, 2 patients with temporal lobe epilepsy and one with posterior quadrant epilepsy achieved Engel class IA, and one patient undergoing hemispherotomy due to Rasmussen encephalitis achieved Engel class IIA. Two patients underwent surgery for hypothalamic hamartoma: one achieved Engel III and the other, Engel IA; however, the latter patient died in the medium term due to a postoperative complication. The other major complication was a case of hydrocephalus, which led to the death of a patient with refractory infantile spasms who underwent corpus callosotomy. CONCLUSIONS Favourable outcomes were observed in 92.5% of patients.
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Affiliation(s)
| | - M López Jiménez
- Servicio de Neurofisiología, Hospital Baca Ortiz, Quito, Ecuador
| | | | | | | | - L Reyes-Haro
- Servicio de Neurofisiología, Hospital Baca Ortiz, Quito, Ecuador
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Morales Chacón LM, Garcia Maeso I, Baez Martin MM, Bender Del Busto JE, García Navarro ME, Quintanal Cordero N, Estupiñan Díaz B, Lorigados Pedre L, Valdés Yerena R, Gonzalez J, Garbey Fernandez R, Sánchez Coroneux A. Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program. Behav Sci (Basel) 2018; 8:bs8020019. [PMID: 29389846 PMCID: PMC5836002 DOI: 10.3390/bs8020019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/10/2018] [Accepted: 01/20/2018] [Indexed: 12/05/2022] Open
Abstract
The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE) patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG) and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA) and absolute spike frequency (ASF) were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28) class I, 10% (4) class II and 19% (8) class III-IV; at 24 months after surgery 55.2% (21) of the patients were class I, 28.9% (11) class II and 15.1% (6) class III-IV. After one- year follow up 23 (57.7%) patients were seizure and aura-free (Engel class IA). These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish “satisfactory” from “unsatisfactory” seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well.
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Affiliation(s)
- Lilia Maria Morales Chacón
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Ivan Garcia Maeso
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Margarita M Baez Martin
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Juan E Bender Del Busto
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | | | - Nelson Quintanal Cordero
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Bárbara Estupiñan Díaz
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Lourdes Lorigados Pedre
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Ricardo Valdés Yerena
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Judith Gonzalez
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Randy Garbey Fernandez
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Abel Sánchez Coroneux
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
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Bruno V, Klein JP, Nidup D, Nirola DK, Tshering L, Deki S, Clark SJ, Linn KA, Shinohara RT, Dorji C, Pokhrel DR, Dema U, Mateen FJ. Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study. Ann Glob Health 2017; 83:415-422. [PMID: 29221514 DOI: 10.1016/j.aogh.2017.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND People with epilepsy (PWE) in low- and middle-income countries may not access the health resources that are considered optimal for epilepsy diagnosis. The diagnostic yield of magnetic resonance imaging (MRI) has not been well studied in these settings. OBJECTIVES To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among PWE in a neurocysticercosis-endemic, resource-limited setting and to identify the proportion and putative structural brain causes of drug-resistant epilepsy. METHODS PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014-2015). Each participant completed clinical questionnaires and a 1.5-Tesla brain MRI. Each MRI was reviewed by at least 1 radiologist and neurologist in Bhutan and the United States. A working definition of drug-resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least 1 seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables. FINDINGS A total of 217 participants (125 [57%] female; 54 [25%] < 18 years old; 199 [92%] taking AEDs; 154 [71%] with a seizure in the prior year) were enrolled. There was a high prevalence of abnormal brain MRIs (176/217, 81%). Mesial temporal sclerosis was the most common finding (n = 115, 53%, including 24 children), exceeding the number of PWE with neurocysticercosis (n = 26, 12%, including 1 child) and congenital/perinatal abnormalities (n = 29, 14%, including 14 children). The number of AEDs (odds ratio = .59, P = .03) and duration of epilepsy (odds ratio = 1.11, P = .02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio = .47, P = .01). A total of 25 (12%) participants met our definition of drug-resistant epilepsy, with mesial temporal sclerosis (n = 10), congenital malformations (n = 5), and neurocysticercosis (n = 4) being the more common findings. CONCLUSIONS The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high as a result of a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug-resistant epilepsy accounted for 12% of the referral population in a conservative estimation.
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Affiliation(s)
- Veronica Bruno
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Joshua P Klein
- Harvard Medical School, Boston, MA; Department of Neurology, Brigham & Women's Hospital, Boston, MA; Department of Radiology, Brigham & Women's Hospital, Boston, MA
| | - Dechen Nidup
- Department of Radiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Damber K Nirola
- Department of Radiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Lhab Tshering
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sonam Deki
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sarah J Clark
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | | | | | - Chencho Dorji
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dili Ram Pokhrel
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ugyen Dema
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Perspectives of epilepsy surgery in resource-poor countries: a study in Georgia. Acta Neurochir (Wien) 2015; 157:1533-40; discussion 1540. [PMID: 26163257 DOI: 10.1007/s00701-015-2496-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND To identify patients with concordant seizure semiology, interictal epileptiform discharges on standard EEG and brain MRI changes to define the patients with pharmacoresistant epilepsy (PRE) who would be suitable for epilepsy surgery according to non-invasive protocol. METHODS The medical records of the patients with epilepsy seen in Epilepsy Center of Institute of Neurology and Neuropsychology (ECINN) (Tbilisi, Georgia) were reviewed retrospectively. The diagnostic work-up included neurological examination, standard EEG, and MRI. The degree of concordance of the seizure semiology, EEG, and neuroimaging was used to determine the potential candidates for surgery. The probability of seizure freedom rate was estimated based on known predictive values of anatomical, electrophysiological, and semiological characteristics. RESULTS A total of 83 (25 %) patients met the criteria of PRE. Fourteen (17 %) patients had complete concordance of seizure semiology, MRI, and EEG. Out of these patients, 11 had mesial temporal sclerosis on MRI and three had focal cortical dysplasia (FCD). Estimated seizure-free surgical success rate in this group was 75-95 % without the need for further investigations. Out of 25 (30 %) non-lesional MRI cases, the concordance of seizure semiology and EEG was in nine patients with probable success rate up to 60 %. Thirteen patients (16 %) had discordant EEG and MRI data and were not suitable for surgery without further testing. CONCLUSIONS A significant portion of PRE patients with concordant anatomical, electrophysiological, and semiological characteristics can be treated surgically in resource-limited countries. Nevertheless, most patients will still require further investigation for proper localization of epileptogenic focus.
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Liu J, Liu Z, Chen T, Xu R. Treatment of epilepsy in China: Formal or informal. Neural Regen Res 2014; 8:3316-24. [PMID: 25206653 PMCID: PMC4145945 DOI: 10.3969/j.issn.1673-5374.2013.35.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 09/02/2013] [Indexed: 11/18/2022] Open
Abstract
Antiepileptic drugs are the preferred treatment approach for epileptic patients. However, informal treatment is important for intractable epilepsy. In this study, 500 epileptic patients were recruited from the General Hospital of Beijing Military Area Command of Chinese PLA during the period of October 2009 to January 2012. These involved patients that had been medically treated for at least 1 year. Information on the initial treatment and changes to treatment regimens for each patient was collected through questionnaires. The survey results showed that 52.3% of the epileptic patients searched for treatment after the first seizure, and the mean numbers of seizures was 12.8; 59.8% of the epileptic patients were diagnosed at the first visit, and the mean onset time was 17 months after the first seizure. After diagnosis, patients were treated for an average of 20 days, and the median time was 1 day. Formal anti-epileptic drugs were selected as the first treatment regimen by 67.8% of patients, and 77.5% of these drugs were monotherapies. The mean and median numbers of seizure were respectively 36.9 and 3.0 times before the first regimen was changed. The regimen was changed within the first 6 months by 46.6% of patients, and after the first and second years of treatment, the proportions increased to 54.0% and 71.8%, respectively. In total, 78.5% of the regimens were changed to informal treatments. The informal treatment of epilepsy in China is common, being initiated by either patients or physicians. Enhancing epileptic treatment services in hospital, improving physicians’ professional quality, and strengthening health propaganda may promote the normalization of drug treatment of epilepsy in China.
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Affiliation(s)
- Jianming Liu
- Bayi Brain Hospital, Affiliated to General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China
| | - Zhiliang Liu
- Bayi Brain Hospital, Affiliated to General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China
| | - Tao Chen
- Laser Institute of Engineering, Beijing University of Technology, Beijing 100080, China
| | - Ruxiang Xu
- Bayi Brain Hospital, Affiliated to General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China
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Manuel CP, Felipe OM. Consideraciones quirúrgicas propias de la epilepsia en niños. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Manuel Campos P, Eduardo Barragán P, Lilian Cuadra O. Realidad actual de las epilepsias en chile y latinoamérica. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70242-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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