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Becker L, Makridis KL, Abad‐Perez AT, Thomale U, Tietze A, Elger CE, Horn D, Kaindl AM. The importance of routine genetic testing in pediatric epilepsy surgery. Epilepsia Open 2024; 9:800-807. [PMID: 38366963 PMCID: PMC10984286 DOI: 10.1002/epi4.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
Genetic variants in relevant genes coexisting with MRI lesions in children with drug-resistant epilepsy (DRE) can negatively influence epilepsy surgery outcomes. Still, presurgical evaluation does not include genetic diagnostics routinely. Here, we report our presurgical evaluation algorithm that includes routine genetic testing. We analyzed retrospectively the data of 68 children with DRE operated at a mean age of 7.8 years (IQR: 8.1 years) at our center. In 49 children, genetic test results were available. We identified 21 gene variants (ACMG III: n = 7, ACMG IV: n = 2, ACMG V: n = 12) in 19 patients (45.2%) in the genes TSC1, TSC2, MECP2, DEPDC5, HUWE1, GRIN1, ASH1I, TRIO, KIF5C, CDON, ANKD11, TGFBR2, ATN1, COL4A1, JAK2, KCNQ2, ATP1A2, and GLI3 by whole-exome sequencing as well as deletions and duplications by array CGH in six patients. While the results did not change the surgery indication, they supported counseling with respect to postoperative chance of seizure freedom and weaning of antiseizure medication (ASM). The presence of genetic findings leads to the postoperative retention of at least one ASM. In our cohort, the International League against Epilepsy (ILAE) seizure outcome did not differ between patients with and without abnormal genetic findings. However, in the 7/68 patients with an unsatisfactory ILAE seizure outcome IV or V 12 months postsurgery, 2 had an abnormal or suspicious genetic finding as a putative explanation for persisting seizures postsurgery, and 3 had received palliative surgery including one TSC patient. This study highlights the importance of genetic testing in children with DRE to address putative underlying germline variants as genetic epilepsy causes or predisposing factors that guide patient and/or parent counseling on a case-by-case with respect to their individual chance of postoperative seizure freedom and ASM weaning. PLAIN LANGUAGE SUMMARY: Genetic variants in children with drug-resistant epilepsy (DRE) can negatively influence epilepsy surgery outcomes. However, presurgical evaluation does not include genetic diagnostics routinely. This retrospective study analyzed the genetic testing results of the 68 pediatric patients who received epilepsy surgery in our center. We identified 21 gene variants by whole-exome sequencing as well as deletions and duplications by array CGH in 6 patients. These results highlight the importance of genetic testing in children with DRE to guide patient and/or parent counseling on a case-by-case with respect to their individual chance of postoperative seizure freedom and ASM weaning.
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Affiliation(s)
- Lena‐Luise Becker
- Department of Pediatric NeurologyCharité – Universitätsmedizin BerlinBerlinGermany
- Center for Chronically Sick ChildrenCharité – Universitätsmedizin BerlinBerlinGermany
- German Epilepsy Center for Children and AdolescentsCharité – Universitätsmedizin BerlinBerlinGermany
- Institute of Cell and NeurobiologyCharité – Universitätsmedizin BerlinBerlinGermany
| | - Konstantin L. Makridis
- Department of Pediatric NeurologyCharité – Universitätsmedizin BerlinBerlinGermany
- Center for Chronically Sick ChildrenCharité – Universitätsmedizin BerlinBerlinGermany
- German Epilepsy Center for Children and AdolescentsCharité – Universitätsmedizin BerlinBerlinGermany
- Institute of Cell and NeurobiologyCharité – Universitätsmedizin BerlinBerlinGermany
| | | | | | - Anna Tietze
- NeuroradiologyCharité – Universitätsmedizin BerlinBerlinGermany
| | | | - Denise Horn
- Institute of Human GeneticsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Angela M. Kaindl
- Department of Pediatric NeurologyCharité – Universitätsmedizin BerlinBerlinGermany
- Center for Chronically Sick ChildrenCharité – Universitätsmedizin BerlinBerlinGermany
- German Epilepsy Center for Children and AdolescentsCharité – Universitätsmedizin BerlinBerlinGermany
- Institute of Cell and NeurobiologyCharité – Universitätsmedizin BerlinBerlinGermany
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De Benedictis A, de Palma L, Rossi-Espagnet MC, Marras CE. Connectome-based approaches in pediatric epilepsy surgery: "State-of-the art" and future perspectives. Epilepsy Behav 2023; 149:109523. [PMID: 37944286 DOI: 10.1016/j.yebeh.2023.109523] [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: 06/25/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Modern epilepsy science has overcome the traditional interpretation of a strict region-specific origin of epilepsy, highlighting the involvement of wider patterns of altered neuronal circuits. In selected cases, surgery may constitute a valuable option to achieve both seizure freedom and neurocognitive improvement. Although epilepsy is now considered as a brain network disease, the most relevant literature concerning the "connectome-based" epilepsy surgery mainly refers to adults, with a limited number of studies dedicated to the pediatric population. In this review, the Authors summarized the main current available knowledge on the relevance of WM surgical anatomy in epilepsy surgery, the post-surgical modifications of brain structural connectivity and the related clinical impact of such modifications within the pediatric context. In the last part, possible implications and future perspectives of this approach have been discussed, especially concerning the optimization of surgical strategies and the predictive value of the epilepsy network analysis for planning tailored approaches, with the final aim of improving case selection, presurgical planning, intraoperative management, and postoperative results.
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Affiliation(s)
| | - Luca de Palma
- Epilepsy and Movement Disorders Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Makridis KL, Kaindl AM. Real-world experience with cenobamate: A systematic review and meta-analysis. Seizure 2023; 112:1-10. [PMID: 37713961 DOI: 10.1016/j.seizure.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE Despite many new ASM, the rate of patients with drug-resistant epilepsy (DRE) has not changed. Cenobamate (CNB) is a novel ASM for the treatment of focal-onset seizures in adults with high seizure freedom rates in randomized controlled trials (RCT). Although CNB appears to be effective, it is not commonly prescribed to patients with DRE, resulting in a lack of "real-world data". METHODS To evaluate the real-world effect of CNB and to assess the generalizability of RCT data, a systematic review and meta-analysis was conducted. Pooled proportions were calculated using a random intercept logistic regression model. RESULTS The analysis included seven studies with a total of 229 patients with DRE, 77.3 % of whom were adults and 91.5 % had focal-onset seizures. Seizure reduction >50 % was achieved in 68 % of patients [54.54; 79.07], with seizure freedom in 16.2 % [8.38; 28.97]. There was no difference between pediatric and adult patients. CNB was discontinued in 10 % [6.74; 14.6] of patients, mostly due to lack of efficacy (39 %) or adverse effects (AE, 43 %). AE, observed in 57.3 % [39.7; 73.2] of patients, included fatigue and vertigo. A comparison of the rates calculated in this meta-analysis to the active arm of equivalent RCTs revealed no significant difference. CONCLUSION CNB achieves a good treatment response in patients with DRE in real-world settings, like the effect reported in RCTs. The high heterogeneity between studies calls for studies focusing on specific DRE subpopulations.
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Affiliation(s)
- Konstantin L Makridis
- Charité - Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Center for Chronically Sick Children, Berlin, Germany; Charité - Universitätsmedizin Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Cell Biology and Neurobiology, Berlin, Germany
| | - Angela M Kaindl
- Charité - Universitätsmedizin Berlin, Department of Pediatric Neurology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Center for Chronically Sick Children, Berlin, Germany; Charité - Universitätsmedizin Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Cell Biology and Neurobiology, Berlin, Germany.
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Makridis KL, Klotz KA, Ramantani G, Becker L, San Antonio‐Arce V, Syrbe S, Wagner K, Shah MJ, Thomale U, Tietze A, Elger CE, Borggraefe I, Kaindl AM. Epilepsy surgery in early infancy: A retrospective, multicenter study. Epilepsia Open 2023; 8:1182-1189. [PMID: 37458529 PMCID: PMC10472416 DOI: 10.1002/epi4.12791] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023] Open
Abstract
Although epilepsy surgery is the only curative therapeutic approach for lesional drug-resistant epilepsy (DRE), there is reluctance to operate on infants due to a fear of complications. A recent meta-analysis showed that epilepsy surgery in the first 6 months of life can achieve seizure control in about two thirds of children. However, robust data on surgical complications and postoperative cognitive development are lacking. We performed a retrospective multicenter study of infants who underwent epilepsy surgery in the first 6 months of life. 15 infants underwent epilepsy surgery at a median age of 134 days (IQR: 58) at four centers. The most common cause was malformation of cortical development, and 13 patients underwent a hemispherotomy. Two thirds required intraoperative red blood transfusions. Severe intraoperative complications occurred in two patients including death in one infant due to cardiovascular insufficiency. At a median follow-up of 1.5 years (IQR: 1.8), 57% of patients were seizure-free. Three patients where reoperated at a later age, resulting in 79% seizure freedom. Anti-seizure medication could be reduced in two thirds, and all patients improved in their development. Our findings suggest that early epilepsy surgery can result in good seizure control and developmental improvement. However, given the perioperative risks, it should be performed only in specialized centers.
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Affiliation(s)
- Konstantin L. Makridis
- Department of Pediatric NeurologyCharité—Universitätsmedizin BerlinBerlinGermany
- Center for Chronically Sick ChildrenCharité—Universitätsmedizin BerlinBerlinGermany
- German Epilepsy Center for Children and AdolescentsCharité—Universitätsmedizin BerlinBerlinGermany
- Institute of Cell‐ and NeurobiologyCharité—Universitätsmedizin BerlinBerlinGermany
| | - Kerstin Alexandra Klotz
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Georgia Ramantani
- Department of NeuropediatricsUniversity Children's Hospital ZurichZurichSwitzerland
- University of ZurichZurichSwitzerland
- Children's Research CentreUniversity Children's Hospital ZurichZurichSwitzerland
| | - Lena‐Luise Becker
- Department of Pediatric NeurologyCharité—Universitätsmedizin BerlinBerlinGermany
- Center for Chronically Sick ChildrenCharité—Universitätsmedizin BerlinBerlinGermany
- German Epilepsy Center for Children and AdolescentsCharité—Universitätsmedizin BerlinBerlinGermany
- Institute of Cell‐ and NeurobiologyCharité—Universitätsmedizin BerlinBerlinGermany
| | - Victoria San Antonio‐Arce
- Freiburg Epilepsy Center, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Steffen Syrbe
- Division of Paediatric Epileptology, Centre for Paediatrics and Adolescent MedicineUniversity Hospital HeidelbergHeidelbergGermany
| | - Kathrin Wagner
- Freiburg Epilepsy Center, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Mukesch Johannes Shah
- Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Anna Tietze
- Institute of Neuroradiology, Charité—Universitätsmedizin BerlinBerlinGermany
| | - Christian E. Elger
- Department of Pediatric NeurologyCharité—Universitätsmedizin BerlinBerlinGermany
- Center for Chronically Sick ChildrenCharité—Universitätsmedizin BerlinBerlinGermany
- German Epilepsy Center for Children and AdolescentsCharité—Universitätsmedizin BerlinBerlinGermany
- Beta Neurologie—Kompetenzzentrum für Epilepsie, Beta Klinik GmbHBonnGermany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's HospitalLMU University Hospital MunichMunichGermany
- Comprehensive Epilepsy CenterLMU University Hospital MunichMunichGermany
| | - Angela M. Kaindl
- Department of Pediatric NeurologyCharité—Universitätsmedizin BerlinBerlinGermany
- Center for Chronically Sick ChildrenCharité—Universitätsmedizin BerlinBerlinGermany
- German Epilepsy Center for Children and AdolescentsCharité—Universitätsmedizin BerlinBerlinGermany
- Institute of Cell‐ and NeurobiologyCharité—Universitätsmedizin BerlinBerlinGermany
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Friedo AL, Greshake B, Makridis KL, Straub HB. Cenobamate significantly improves seizure control in intellectually disabled patients with drug-resistant epilepsy and allows drug load reduction. Front Neurol 2023; 14:1209487. [PMID: 37528853 PMCID: PMC10390252 DOI: 10.3389/fneur.2023.1209487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Epilepsy patients with intellectual disability often suffer from drug-resistant epilepsy (DRE), which severely affects patients' quality of life. Cenobamate (CNB) is a recently approved novel and effective ASM that can achieve high rates of seizure freedom in previously drug-resistant patients. Methods We performed a retrospective data analysis of the first patients treated with CNB at a single center. Outcome and treatment response were assessed at two different time points, and ASM burden was calculated. Results A 12 patients (7 males and 5 females) began treatment at a median age of 43 years, six of whom had developmental and epileptic encephalopathies. Prior to treatment with CNB, patients had tried a median of 13 different ASM. At the start of CNB therapy, patients were taking a median of 3 ASM. Treatment outcomes were available for 11 patients. After the first follow-up period (median 9 months), 55% of patients showed a significant seizure reduction of more than 50%, with three patients showing a reduction of more than 75% (27%). One patient achieved complete seizure freedom, while one patient did not respond to treatment. These response rates were consistently maintained at second follow-up after a median of 22 months. Ten patients (83%) reported adverse events (AE), the most common of which were dizziness and fatigue. No cases of drug reactions with eosinophilia and systemic symptoms (DRESS) were observed. The majority of AEs were mild and resolved over time. In addition, most patients were able to reduce their concomitant ASM. Discussion Cenobamate has been shown to be an effective ASM in patients with DRE and in patients with intellectual disabilities. After more than 1 year of treatment with CNB, close monitoring and management of drug-drug interactions may reduce enzyme-inducing ASMs and lead to better long-term outcomes. With CNB treatment, many patients can achieve a reduced overall drug burden while maintaining a reduction in seizures.
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Affiliation(s)
| | | | - Konstantin L. Makridis
- Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Chronically Sick Children, Charité – Universitätsmedizin Berlin, Berlin, Germany
- German Epilepsy Center for Children and Adolescents, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Cell Biology and Neurobiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Makridis KL, Hoyer S, Elger CE, Kaindl AM. Is There a Cognitive Decline in Pediatric Patients Following Epilepsy Surgery? Pediatr Neurol 2023; 144:44-49. [PMID: 37146539 DOI: 10.1016/j.pediatrneurol.2023.03.020] [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: 05/15/2022] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Epilepsy surgery is currently the only way to cure drug-resistant epilepsy (DRE). The loss of epileptic activity or its propagation in the developing brain may not only result in seizure freedom but also be associated with further positive effects. Here, we analyzed the cognitive development of children and adolescents with DRE after epilepsy surgery. METHODS We evaluated retrospectively the cognitive development of children and adolescents before and after epilepsy surgery. RESULTS Fifty-three children and adolescents underwent epilepsy surgery at a median age of 7.62 years. Overall seizure freedom was 86.8% at a current median observation period of 20 months. Presurgically, 81.1% had the clinical diagnosis of cognitive impairment, which was confirmed by standardized tests in 43 of 53 patients (76.7%). Further 10 patients had severe cognitive impairment rendering a standardized test impossible. The median intelligence quotient (IQ)/development quotient value was 74. After surgery, caretakers reported developmental progress in all patients, whereas the median IQ decreased slightly (P = 0.404). In eight patients the IQ points decreased after surgery; however, their individual raw scores increased in line with their reported increase in cognitive abilities. CONCLUSIONS We did not detect any cognitive deterioration in children following epilepsy surgery. A loss of IQ points did not correspond to a real loss of cognitive abilities. These patients developed more slowly than age-matched peers with an average development speed but profited individually as seen in their raw scores. Therefore, an individual analysis of raw scores is relevant to assess the cognitive development after surgery.
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Affiliation(s)
- Konstantin L Makridis
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell- and Neurobiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Hoyer
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian E Elger
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Beta Neurologie - Kompetenzzentrum für Epilepsie, Beta Klinik GmbH, Bonn, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell- and Neurobiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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7
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Hoyer S, Makridis KL, Atalay DA, Thomale UW, Prager C, Elger CE, Kaindl AM. Family Burden and Epilepsy Surgery in Children with Drug-Resistant Epilepsy. Neuropediatrics 2023; 54:182-187. [PMID: 36921608 DOI: 10.1055/s-0043-1764215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Family burden (FB) in pediatric patients with drug-resistant epilepsy (DRE) is significantly higher than that in children with non-DRE. Epilepsy surgery is an established approach to treat DRE, and this study examines the impact of pediatric epilepsy surgery on FB. METHODS We retrospectively analyzed data of families and pediatric patients with focal structural DRE treated with epilepsy surgery at our epilepsy center from April 2018 to November 2021. We examined the relationship between cognitive, behavioral, and epilepsy-specific data and the FB measured with the German version of the Impact on Family Scale before and after epilepsy surgery. RESULTS The study cohort included 31 children with DRE at a mean age of 9 years at surgery (range = 0-16) and a mean epilepsy duration of 3 years (range = 0-14). Cognitive impairment correlated with FB in children with DRE prior to surgery. At the last assessment, 14.5 months (mean, range = 6-24) after epilepsy surgery, 87.2% of patients were seizure-free, FB values had decreased by 75.0%, and behavioral problems had decreased by 85,7%. Cognitive functions remained stable following epilepsy surgery. CONCLUSION In children with DRE, epilepsy surgery reduces FB. Given the considerable impact of families on the development and wellbeing of their children, the impact of epilepsy surgery should be communicated to affected families.
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Affiliation(s)
- Sebastian Hoyer
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Konstantin L Makridis
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Institute of Cell Biology and Neurobiology, Berlin, Germany
| | - Deniz A Atalay
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich-W Thomale
- Department of Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christine Prager
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian E Elger
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Beta Neurologie - Kompetenzzentrum für Epilepsie, Beta Klinik GmbH, Bonn, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Institute of Cell Biology and Neurobiology, Berlin, Germany
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Garavatti E, Yamamoto E, Collins K, Selden N, Bushlin I. Surgical Resection of Focal Cortical Dysplasia in a Neonate with Novel TSC1 Mutation Leading to Resolution of Refractory Seizures: Case Report. Child Neurol Open 2023; 10:2329048X231219223. [PMID: 38107744 PMCID: PMC10722926 DOI: 10.1177/2329048x231219223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
We describe a neonate presenting on first day of life with refractory seizures secondary to a single, large area of focal cortical dysplasia (FCD) who underwent surgical resection at age 3 weeks leading to resolution of seizure activity and dramatic improvement in developmental trajectory. Surgical intervention for epilepsy is infrequently offered for neonates, often reserved only for those with catastrophic presentations. This case demonstrates that surgical intervention can be safe and efficacious in neonates for pharmaco-resistant seizures associated with a focal lesion. Rapid whole exome sequencing in this case yielded a germline novel de novo TSC1 mutation, leading to a genetic diagnosis of tuberous sclerosis complex (TSC). Our patient demonstrates an atypical neonatal presentation of TSC. Limited data is available for those with isolated FCD in TSC; this is the first reported case in a neonate.
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Affiliation(s)
- Emily Garavatti
- Neurodevelopmental Disabilities, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Erin Yamamoto
- Neurosurgery, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Kelly Collins
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA
| | - Nathan Selden
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA
| | - Ittai Bushlin
- Department of Pediatric Neurology, Oregon Health & Science University, Portland, OR, USA
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Makridis KL, Bast T, Prager C, Kovacevic-Preradovic T, Bittigau P, Mayer T, Breuer E, Kaindl AM. Real-World Experience Treating Pediatric Epilepsy Patients With Cenobamate. Front Neurol 2022; 13:950171. [PMID: 35937072 PMCID: PMC9350548 DOI: 10.3389/fneur.2022.950171] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction In one third of all patients with epilepsy, seizure freedom is not achieved through anti-seizure medication (ASM). These patients have an increased risk of earlier death, poorer cognitive development, and reduced quality of life. Cenobamate (CNB) has recently been approved as a promising novel ASM drug for the treatment of adults with focal-onset epilepsy. However, there is little experience for its application in pediatric patients. Methods In a multicenter study we evaluated retrospectively the outcome of 16 pediatric patients treated “off label” with CNB. Results In 16 patients with a mean age of 15.38 years, CNB was started at an age of 15.05 years due to DRE. Prior to initiation of therapy, an average of 10.56 (range 3–20) ASM were prescribed. At initiation, patients were taking 2.63 (range 1–4) ASM. CNB was increased by 0.47 ± 0.27mg/kg/d every 2 weeks with a mean maximum dosage of 3.1 mg/kg/d (range 0.89–7) and total daily dose of 182.81 mg (range 50–400 mg). Seizure freedom was achieved in 31.3% and a significant seizure reduction of >50% in 37.5%. Adverse events occurred in 10 patients with fatigue/somnolence as the most common. CNB is taken with high adherence in all but three patients with a median follow-up of 168.5 days Conclusion Cenobamate is an effective ASM for pediatric patients suffering from drug-resistant epilepsy. In addition to excellent seizure reduction or freedom, it is well-tolerated. Cenobamate should be considered as a novel treatment for DRE in pediatric patients.
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Affiliation(s)
- Konstantin L. Makridis
- Department of Pediatric Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Center for Chronically Sick Children, Charité–Universitätsmedizin Berlin, Berlin, Germany
- German Epilepsy Center for Children and Adolescents, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute of Cell- and Neurobiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Bast
- Epilepsiezentrum Kork, Diakonie Kork, Kehl, Germany
| | - Christine Prager
- Department of Pediatric Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Center for Chronically Sick Children, Charité–Universitätsmedizin Berlin, Berlin, Germany
- German Epilepsy Center for Children and Adolescents, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Petra Bittigau
- Department of Pediatric Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Center for Chronically Sick Children, Charité–Universitätsmedizin Berlin, Berlin, Germany
- German Epilepsy Center for Children and Adolescents, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Mayer
- Epilepsiezentrum Kleinwachau gemeinnützige GmbH, Radeberg, Germany
| | - Eva Breuer
- Epilepsie-Zentrum Berlin-Brandenburg, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Angela M. Kaindl
- Department of Pediatric Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Center for Chronically Sick Children, Charité–Universitätsmedizin Berlin, Berlin, Germany
- German Epilepsy Center for Children and Adolescents, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute of Cell- and Neurobiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Angela M. Kaindl
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