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Jaafar F, Obeid M, Beydoun A. Role of Early Intravenous Immunoglobulins in Halting Clinical and Radiographic Disease Progression in Rasmussen Encephalitis. Pediatr Neurol 2023; 145:30-35. [PMID: 37269621 DOI: 10.1016/j.pediatrneurol.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/29/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Rasmussen encephalitis (RE) is a rare progressive presumed autoimmune disorder characterized by pharmacoresistant epilepsy and progressive motor and cognitive deterioration. Despite immunomodulation, more than half of the patients with RE ultimately require functional hemispherotomy. In this study, we evaluated the potential beneficial effects of early initiation of immunomodulation in slowing disease progression and preventing the need for surgical interventions. METHODS A retrospective chart review over a 10-year period was conducted at the American University of Beirut Medical Center to identify patients with RE. Data were collected on seizure characteristics, neurological deficits, electroencephalography, brain magnetic resonance imaging results (including volumetric analyses for an objective assessment of radiographic progression), and treatment modalities. RESULTS Seven patients met the inclusion criteria for RE. All patients received intravenous immunoglobulins (IVIGs) as soon as the diagnosis was entertained. Five patients with only monthly to weekly seizures at the time of IVIG initiation had favorable outcomes without resorting to surgery, along with a relative preservation of the gray matter volumes in the affected cerebral hemispheres. Motor strength was preserved in those patients, and three were seizure free at their last follow-up visit. The two patients who required hemispherotomy were already severely hemiparetic and experiencing daily seizures at the time of IVIG initiation. CONCLUSIONS Our data suggest that the early initiation of IVIG as soon as a diagnosis of RE is suspected, and particularly before the appearance of motor deficits and intractable seizures, can maximize the beneficial effects of immunomodulation in terms of controlling seizures and reducing the rate of cerebral atrophy.
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Affiliation(s)
- Fatima Jaafar
- Division of Child Neurology, Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Makram Obeid
- Division of Child Neurology, Department of Neurology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana.
| | - Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
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2
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Seto ES, Coorg R. Epilepsy Surgery: Monitoring and Novel Surgical Techniques. Neurol Clin 2021; 39:723-742. [PMID: 34215384 DOI: 10.1016/j.ncl.2021.04.001] [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: 10/21/2022]
Abstract
Drug-resistant epilepsy warrants referral to an epilepsy surgery center for consideration of alternative treatments including epilepsy surgery. Advances in technology now allow for minimally invasive neurophysiologic monitoring and surgical interventions, approaches that are attractive to families because large craniotomies and associated morbidity are avoided. This work reviews the presurgical evaluation process and discusses the use of invasive stereo-electroencephalography monitoring to localize seizure onset zones. Minimally invasive surgical techniques are described for the treatment of focal and generalized epilepsies. These approaches have expanded our capacity to palliate and cure epilepsy in the pediatric population.
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Affiliation(s)
- Elaine S Seto
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA.
| | - Rohini Coorg
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA
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Li ST, Chiu NC, Kuo YT, Shen EY, Tsai PC, Ho CS, Wu WH, Chen JC. Parenting stress in parents of children with refractory epilepsy before and after vagus nerve stimulation implantation. Pediatr Neonatol 2017; 58:516-522. [PMID: 28566195 DOI: 10.1016/j.pedneo.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/18/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate parenting stress in parents of children with refractory epilepsy before and after their children received vagus nerve stimulation (VNS) implantation. METHODS Parents of children with refractory epilepsy completed the Parenting Stress Index (PSI) under a psychologist's assessment before and at least 12 months after their children received VNS implantation. The PSI questionnaire measures parenting stress in two domains; a parent domain with seven subscales, and a child domain with six. Age, gender, epilepsy comorbidity, VNS implantation date, seizure frequency, and anticonvulsant history before and after VNS implantation were obtained from reviews of medical charts. RESULTS In total, 30 parents completed the first and follow-up PSI questionnaires. Seventeen of their children (56.7%) were boys. The children aged from 1 to 12 years (7.43 ± 3.59 years, mean ± SD). After VNS implantation, the mean total parenting stress scores decreased from 282.1 ± 38.0 to 272.4 ± 42.9. A significant decrease was found on the spouse subscale of the parent domain. For the parents of boys, the mean total parenting stress scores decreased significantly. The mean total parenting stress scores also decreased significantly for parents of epileptic children without autism and who did not taper off the number of different anticonvulsants used after VNS. CONCLUSIONS VNS is an advisable choice to treat refractory epilepsy. Our study showed that 12 months or more after VNS implantation, seizure frequency and parenting stress typically decreased. However, in some special cases the parenting stress may increase, and external help may be required to support these patients and their parents.
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Affiliation(s)
- Sung-Tse Li
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan; Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, MacKay Medical College, New Taipei City, Taiwan; Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan.
| | - Yung-Ting Kuo
- Department of Pediatrics, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
| | - Ein-Yiao Shen
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Chieh Tsai
- Clinic Psychologist, Department of Psychiatry, Cender Hospital, Taichung, Taiwan
| | - Che-Sheng Ho
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Wen-Hsiang Wu
- Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Juei-Chao Chen
- Department of Statistics and Information Science, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
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Choi SA, Kim SY, Kim H, Kim WJ, Kim H, Hwang H, Choi JE, Lim BC, Chae JH, Chong S, Lee JY, Phi JH, Kim SK, Wang KC, Kim KJ. Surgical outcome and predictive factors of epilepsy surgery in pediatric isolated focal cortical dysplasia. Epilepsy Res 2017; 139:54-59. [PMID: 29197666 DOI: 10.1016/j.eplepsyres.2017.11.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/26/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is a common cause of medically intractable epilepsy in children. Epilepsy surgery has been a valuable treatment option to achieve seizure freedom in these intractable epilepsy patients. We aimed to present long-term surgical outcome, in relation to pathological severity, and to assess predictive factors of epilepsy surgery in pediatric isolated FCD. METHODS We retrospectively analyzed the data of 58 children and adolescents, with FCD International League Against Epilepsy (ILAE) task force classification types I and II, who underwent resective epilepsy surgery and were followed for at least 2 years after surgery. RESULTS The mean age at epilepsy onset was 4.3 years (0-14.2 years), and mean age at epilepsy surgery was 9.4 years (0.4-17.5 years). The mean duration of postoperative follow-up was 5.1±2.6 years (2-12.4 years). Of 58 patients, 62% of patients achieved Engel class I at 2 years postoperatively, 58% at 5 years postoperatively, and 53% at the last follow up. Forty eight percent of our cohort successfully discontinued antiepileptic medication. Of 30 patients with seizure recurrence, 83% of seizures recurred within 2 years after surgery. We observed that FCD type IIb was significantly associated with a better surgical outcome. At fifth postoperative year, 88% of FCD IIb patients were seizure free compared with 21% of type I and 57% of type IIa patients (P=0.043). By multivariate analysis, lesion on MRI (P=0.02) and complete resection (P<0.01) were the most important predictive factors for a seizure-free outcome. SIGNIFICANCE Epilepsy surgery is highly effective; more than half of medically intractable epilepsy patients achieved seizure freedom after surgery. In addition, we found significant difference in surgical outcomes according to the ILAE task force classification. Lesion on MRI and complete resection were the most important predictive factors for favorable seizure outcome in isolated FCD patients.
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Affiliation(s)
- Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyuna Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ji Eun Choi
- Department of Pediatrics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sangjoon Chong
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Barba C, Specchio N, Guerrini R, Tassi L, De Masi S, Cardinale F, Pellacani S, De Palma L, Battaglia D, Tamburrini G, Didato G, Freri E, Consales A, Nozza P, Zamponi N, Cesaroni E, Di Gennaro G, Esposito V, Giulioni M, Tinuper P, Colicchio G, Rocchi R, Rubboli G, Giordano F, Lo Russo G, Marras CE, Cossu M. Increasing volume and complexity of pediatric epilepsy surgery with stable seizure outcome between 2008 and 2014: A nationwide multicenter study. Epilepsy Behav 2017; 75:151-157. [PMID: 28866334 DOI: 10.1016/j.yebeh.2017.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to assess common practice in pediatric epilepsy surgery in Italy between 2008 and 2014. METHODS A survey was conducted among nine Italian epilepsy surgery centers to collect information on presurgical and postsurgical evaluation protocols, volumes and types of surgical interventions, and etiologies and seizure outcomes in pediatric epilepsy surgery between 2008 and 2014. RESULTS Retrospective data on 527 surgical procedures were collected. The most frequent surgical approaches were temporal lobe resections and disconnections (133, 25.2%) and extratemporal lesionectomies (128, 24.3%); the most frequent etiologies were FCD II (107, 20.3%) and glioneuronal tumors (105, 19.9%). Volumes of surgeries increased over time independently from the age at surgery and the epilepsy surgery center. Engel class I was achieved in 73.6% of patients (range: 54.8 to 91.7%), with no significant changes between 2008 and 2014. Univariate analyses showed a decrease in the proportion of temporal resections and tumors and an increase in the proportion of FCDII, while multivariate analyses revealed an increase in the proportion of extratemporal surgeries over time. A higher proportion of temporal surgeries and tumors and a lower proportion of extratemporal and multilobar surgeries and of FCD were observed in low (<50surgeries/year) versus high-volume centers. There was a high variability across centers concerning pre- and postsurgical evaluation protocols, depending on local expertise and facilities. SIGNIFICANCE This survey reveals an increase in volume and complexity of pediatric epilepsy surgery in Italy between 2008 and 2014, associated with a stable seizure outcome.
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Affiliation(s)
- Carmen Barba
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy.
| | - Nicola Specchio
- Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy; IRCCS Stella Maris, Pisa, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Salvatore De Masi
- Clinical Trial Office, Children's Hospital Anna Meyer, Florence, Italy
| | | | - Simona Pellacani
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Luca De Palma
- Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Giuseppe Didato
- Clinical and Experimental Epileptology, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | | | - Paolo Nozza
- Anatomical Pathology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Nelia Zamponi
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi-University of Ancona, Ancona, Italy
| | - Elisabetta Cesaroni
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi-University of Ancona, Ancona, Italy
| | | | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Neurology and Psychiatry, University of Rome "La Sapienza", Rome, Italy
| | - Marco Giulioni
- Division of Neurosurgery, IRCCS - Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Paolo Tinuper
- Division of Neurology, IRCCS - Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | | | - Raffaele Rocchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Guido Rubboli
- Danish Epilepsy Centre, Filadelfia/University of Copenhagen, Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Neurology Unit, Bellaria Hospital, Bologna, Italy
| | - Flavio Giordano
- Neurosurgery Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Efisio Marras
- Pediatric Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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Downes M, Greenaway R, Clark M, Helen Cross J, Jolleff N, Harkness W, Kaliakatsos M, Boyd S, White S, Neville BGR. Outcome following multiple subpial transection in Landau-Kleffner syndrome and related regression. Epilepsia 2015; 56:1760-6. [DOI: 10.1111/epi.13132] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rebecca Greenaway
- UCL Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - Maria Clark
- UCL Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - J. Helen Cross
- UCL Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | | | - William Harkness
- UCL Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - Marios Kaliakatsos
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - Stewart Boyd
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
| | - Steve White
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
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Seizure outcomes in children with epilepsy after resective brain surgery. Eur J Paediatr Neurol 2015; 19:577-83. [PMID: 26095098 DOI: 10.1016/j.ejpn.2015.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 04/25/2015] [Accepted: 05/27/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the role of resective brain surgery in childhood epilepsy. METHODOLOGY We retrospectively analysed the seizure outcomes in 55 children with epilepsy who had resective brain surgery between 1997 and 2012, at our centre. The children were 1.5-18 years at the time of surgery; their seizure onset was between 0.2 andto 15 years of age. 48 had refractory epilepsy. One child died of tumour progression. Follow-up duration in the survivors ranged from 2 to -16 years (mean: 9).Presurgical evaluation included clinical profiles, non-invasive V-EEG monitoring, neuroimaging with MRIs in all; SPECT and PET in selected patients. 54 had intraoperative ECoG. RESULTS An Engel Class 1 outcome was seen in 78% of the cohort, with 67% being off all AEDs at the most recent follow-up. Children with tumours constituted the majority (56%), with 87% of this group showing a Class 1 outcome and 84% being off AEDs. Children with cortical dysplasia had a Class 1 outcome in 56%. CONCLUSION Resective brain surgery is an efficacious option in some children with epilepsy. We found ECoG useful to tailor the cortical resection and in our opinion ECoG contributed to the good seizure outcomes.
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Ilyas M, Sivaswamy L, Asano E, Sood S, Zidan M, Chugani H. Seizure control following palliative resective surgery for intractable epilepsy-a pilot study. Pediatr Neurol 2014; 51:330-5. [PMID: 25160538 DOI: 10.1016/j.pediatrneurol.2014.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/19/2014] [Accepted: 05/04/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with intractable epilepsy who have bilateral epileptic foci may not qualify for curative epilepsy surgery. In some cases palliative resection may be undertaken with a goal to decrease seizure frequency and improve quality of life. Here we present data on the outcome of palliative epilepsy surgery in children. METHODS We reviewed medical charts of children who underwent palliative resection for intractable epilepsy during the years 1999-2013 at Children's Hospital of Michigan. The palliative intent of resection was declared preoperatively. Outcome was assessed in terms of seizure reduction. RESULTS There were 18 patients (11 males, median age of surgery was 3.5 years [range 0.5-16 years]). The median duration of follow-up after surgery was 12.5 months (range 6-60 months). Hemispherectomy was the most commonly performed palliative resection (nine patients), followed by lobectomy (six patients), multilobar resection (one patient), and tuberectomy (two patients). Reduction in seizure frequency was observed in 11 patients, with eight patients achieving seizure freedom on antiepileptic drugs and three with >50% reduction in seizure frequency. Transient improvement in seizure frequency occurred in two patients, whereas there was no benefit in five patients. CONCLUSIONS Beneficial effects of epilepsy surgery may be realized in carefully selected situations wherein the most epileptogenic focus is resected to reduce seizure burden and improve quality of life.
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Affiliation(s)
- Mohammed Ilyas
- Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan.
| | - Lalitha Sivaswamy
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Eishi Asano
- Children's Hospital of Michigan, Detroit, Michigan
| | - Sandeep Sood
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Marwan Zidan
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Research Center of Michigan, Detroit, Michigan
| | - Harry Chugani
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
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Hamad AP, Caboclo LO, Centeno R, Costa LV, Ladeia-Frota C, Carrete H, Gomez NG, Marinho M, Yacubian EMT, Sakamoto AC. Hemispheric surgery for refractory epilepsy in children and adolescents: Outcome regarding seizures, motor skills and adaptive function. Seizure 2013; 22:752-6. [DOI: 10.1016/j.seizure.2013.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/31/2013] [Accepted: 06/03/2013] [Indexed: 11/26/2022] Open
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Miserocchi A, Cascardo B, Piroddi C, Fuschillo D, Cardinale F, Nobili L, Francione S, Russo GL, Cossu M. Surgery for temporal lobe epilepsy in children: relevance of presurgical evaluation and analysis of outcome. J Neurosurg Pediatr 2013; 11:256-67. [PMID: 23311387 DOI: 10.3171/2012.12.peds12334] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors' goal in this paper was to retrospectively evaluate the relevance of the presurgical workup and the postoperative outcome in children (< 15 years) who undergo surgery for temporal lobe epilepsy (TLE). METHODS The authors performed a retrospective analysis of 68 patients (43 boys and 25 girls) who underwent resection for TLE between 2001 and 2010 at a single center and had a minimum postoperative follow-up of 12 months. Presurgical investigations included full clinical evaluation, interictal electroencephalography (EEG), and MRI in all cases; cognitive evaluation in patients older than 5 years; scalp video-EEG in 46 patients; and invasive EEG in 3 patients. Clinical evaluation included a careful assessment of ictal semiology (based on anamnestic reports or video-EEG review), with particular attention to early signs and/or symptoms suggestive of temporal lobe origin of the seizure. Microsurgical resections were performed within the anatomical limits of the temporal lobe, and surgical specimens were processed for histological examination. Postoperative assessment of seizure outcome (Engel classification system) and cognitive performance was conducted at regular intervals. The effect on postoperative seizure outcome (good = Engel Class I; poor = Engel Classes II-IV) of several presurgical and surgical variables was investigated by bivariate statistical analysis. RESULTS All patients had at least 1 early sign or symptom suggesting a temporal lobe origin of their seizures. Lateralized interictal or ictal EEG abnormalities were seen in all patients, and they were localized to the temporal lobe in 45 patients. In all cases MRI demonstrated a structural abnormality. Surgery consisted of a tailored anterior temporal lobectomy in 64 patients and a neocortical lesionectomy in 4 patients. Postoperatively, 58 patients (85%) were in Engel Class I. Variables significantly associated with a poor outcome were preoperative sensory motor deficit (p = 0.019), mental retardation (p = 0.003), MRI abnormalities extending outside the temporal lobe (p = 0.0018), history of generalized seizures (p = 0.01) or status epilepticus (p = 0.008), unremarkable histology (p = 0.001), seizures immediately postoperatively (p = 0.00001), and ipsilateral epileptiform activity on postoperative EEG (p = 0.005). At postoperative neuropsychological assessment, the percentage of patients with a pathological score at the final visit invariably decreased compared with that at the preoperative evaluation in all considered cognitive domains. CONCLUSIONS Among the study population, a surgical selection based on a noninvasive evaluation was possible in most patients. The invaluable information resulting from the rigorous noninvasive electroclinical and neuroimaging evaluation can lead to excellent surgical results without the use of invasive, time-consuming, and expensive diagnostic tools. The potential reduction of invasiveness-related risks, complexity, and costs of presurgical investigations should hopefully allow for an increase in the number of children with TLE who will receive surgery, particularly in centers with limited technological resources.
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Affiliation(s)
- Anna Miserocchi
- C. Munari Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
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11
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Aaberg KM, Eriksson AS, Ramm-Pettersen J, Nakken KO. Long-term outcome of resective epilepsy surgery in Norwegian children. Acta Paediatr 2012; 101:e557-60. [PMID: 22924953 DOI: 10.1111/j.1651-2227.2012.02834.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to evaluate the long-term results of resective surgery on children with difficult-to-treat epilepsy in Norway. METHODS In the period 1995-2004, 64 surgical procedures (54 resections and 10 functional hemispherotomies) were performed in 54 children. The children's medical records were retrospectively reviewed at a minimum of 2 years after surgery. We sent a questionnaire regarding their epilepsy (seizures, usage of antiepileptic drugs) and general functioning (social situation, motor, language, cognition, behavioural or emotional problems, any remedial action) to the children/parents after a mean follow-up period of 7 years. RESULTS 55.5% of the children were seizure-free. The success rate varied according to the type of surgery. Best results were found after functional hemispherotomies and temporal lobe resections, as nine of 10 (90%) and 10 of 19 (53%) of these patients, respectively, became seizure-free. In addition to a better seizure control, 71% of the children/parents reported of a better cognitive and psychosocial functioning. CONCLUSION The results of epilepsy surgery in this paediatric cohort are very edifying, and it is our impression that this treatment option is underused in Norway.
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Affiliation(s)
- K M Aaberg
- National Center for Epilepsy, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway.
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12
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Ciliberto MA, Limbrick D, Powers A, Titus JB, Munro R, Smyth MD. Palliative hemispherotomy in children with bilateral seizure onset. J Neurosurg Pediatr 2012; 9:381-8. [PMID: 22462702 DOI: 10.3171/2011.12.peds11334] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intractable epilepsy is a significant burden on families and on the cognitive development and quality of life (QOL) of patients. Periinsular hemispherotomy (PIH) for medically intractable epilepsy can benefit patients who qualify for this procedure. The ideal hemispherotomy candidate has ipsilateral ictal and interictal epileptiform activity, unilateral MR imaging abnormalities, contralateral hemiplegia, and a normal contralateral hemisphere. However, certain patients present with a mixed picture of bilateral electroencephalography (EEG) findings and severe intractable epilepsy, prompting consideration of a more aggressive treatment approach. This report introduces the possibility of surgery for patients who normally would not meet criteria for this treatment modality. METHODS In this retrospective chart review, the authors report on 7 patients with bilateral seizure onset noted on routine or video-EEG monitoring. A QOL phone questionnaire, based on the Quality of Life in Childhood Epilepsy tool, was administered to a parent. The authors reviewed each patient's chart for surgical complications, changes in examination, QOL, limited neuropsychological outcomes, and seizure outcomes. They also investigated each chart for MR imaging and EEG findings as well as the patient's epilepsy clinic notes for seizure semiology and frequency. RESULTS All patients enjoyed a decrease in seizure frequency and a subjective increase in QOL after PIH. Five patients (71%) achieved Engel Class I or II seizure control. The mean follow-up was 3.64 years (2-5.3 years). One patient is now off all antiseizure medication. No patient had a decrement in Full Scale IQ on postsurgical testing, and 2 (28.5%) of 7 individuals had increased adaptive and social functioning. Postsurgical examination changes included hemiplegia and homonymous hemianopia. CONCLUSIONS Hemispherotomy in patients with intractable epilepsy is generally reserved for individuals with unilateral epileptiform abnormalities or lesions on MR imaging. Seven patients in this study benefited from surgery despite bilateral seizure onset with improvement in seizure control and overall QOL. Thus, bilateral ictal onset does not necessarily preclude consideration for hemispherotomy in selected patients with severe medically refractory epilepsy.
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Affiliation(s)
- Michael Anthony Ciliberto
- Departments of Developmental and Pediatric Neurology, Washington University, St. Louis, MO 63110, USA.
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Mikati MA, Nabulsi Khalil M, Steele SU. Principles of drug treatment in children. HANDBOOK OF CLINICAL NEUROLOGY 2012; 108:699-722. [PMID: 22939061 DOI: 10.1016/b978-0-444-52899-5.00023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Mohamad A Mikati
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
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Hauptman JS, Mathern GW. Epilepsy neurosurgery in children. HANDBOOK OF CLINICAL NEUROLOGY 2012; 108:881-95. [PMID: 22939072 DOI: 10.1016/b978-0-444-52899-5.00034-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Jason S Hauptman
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
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Novegno F, Massimi L, Chieffo D, Battaglia D, Frassanito P, Bianco LF, Tartaglione T, Tamburrini G, Di Rocco C, Guzzetta F. Epilepsy surgery of posterior quadrant dysplasia in the first year of life: experience of a single centre with long term follow-up. Seizure 2010; 20:27-33. [PMID: 20951066 DOI: 10.1016/j.seizure.2010.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 09/14/2010] [Accepted: 09/17/2010] [Indexed: 11/30/2022] Open
Abstract
Posterior quadrant dysplasia (PQD) is a rare variant of cortical dysplasia involving the posterior regions of a single hemisphere. It is always associated with early onset, refractory epilepsy often characterized by a "catastrophic" evolution. The experience on its surgical management during the first year of life is limited to sporadic, isolated cases. Between 2002 and 2005, four children less than one-year-old and affected by drug-resistant epilepsy associated with PQD were admitted to our Institution and underwent surgical treatment. One patient remained seizure-free during all the follow-up (Engel I). The remaining three children showed a recurrence of the seizures, requiring subsequent surgical procedures in two cases. In one case (Engel II), the seizure control has been obtained thanks to pharmacological treatment. The other two patients respectively had only a partial (Engel III) and a less relevant reduction of the number of seizures (Engel IV). Both the epileptic and the neuropsychological outcome of our series were significantly influenced by persistent contralateral interictal anomalies rather than by the timing of the surgical procedure. Unpredictable results should be expected in this kind of patients if there is the detection of contralateral independent epileptiform activities on the EEG at diagnosis. Parents and relatives should be aware of the results' variability, even though a reduction of seizures may be expected, enabling an easier handling of the child's condition.
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Affiliation(s)
- F Novegno
- Pediatric Neurosurgery, Catholic University Medical School, Largo A. Gemelli 1, 00168 Rome, Italy.
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Quality of life after surgery for intractable partial epilepsy in children: A cohort study with controls. Epilepsy Res 2010; 90:207-13. [DOI: 10.1016/j.eplepsyres.2010.05.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 03/24/2010] [Accepted: 05/02/2010] [Indexed: 11/20/2022]
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Noachtar S, Borggraefe I. Epilepsy surgery: a critical review. Epilepsy Behav 2009; 15:66-72. [PMID: 19236942 DOI: 10.1016/j.yebeh.2009.02.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 10/21/2022]
Abstract
The objective of surgical treatment of epilepsy is seizure control and improvement of quality-of-life of patients with medically intractable epilepsy. Confirmation of the diagnosis of epilepsy and its medical intractability is the essential prerequisite for epilepsy surgery. After excluding nonepileptic events such as psychogenic pseudoseizures, the clinician must establish that adequate drug trials, including verification of compliance, have been performed. A careful diagnostic evaluation is mandatory to localize the epileptogenic zone. In this review we discuss the role of different diagnostic methods with respect to patient selection and surgical outcome. Furthermore, experimental approaches are mentioned and the reasons for failures of epilepsy surgery are critically discussed.
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Affiliation(s)
- Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany.
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