1
|
Goel K, Ghadiyaram A, Krishnakumar A, Morden FTC, Higashihara TJ, Harris WB, Shlobin NA, Wang A, Karunungan K, Dubey A, Phillips HW, Weil AG, Fallah A. Hemimegalencephaly: A Systematic Comparison of Functional and Anatomic Hemispherectomy for Drug-Resistant Epilepsy. Neurosurgery 2024; 94:666-678. [PMID: 37975663 DOI: 10.1227/neu.0000000000002759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/19/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hemimegalencephaly (HME) is a rare diffuse malformation of cortical development characterized by unihemispheric hypertrophy, drug-resistant epilepsy (DRE), hemiparesis, and developmental delay. Definitive treatment for HME-related DRE is hemispheric surgery through either anatomic (AH) or functional hemispherectomy (FH). This individual patient data meta-analysis assessed seizure outcomes of AH and FH for HME with pharmacoresistant epilepsy, predictors of Engel I, and efficacy of different FH approaches. METHODS PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched from inception to Jan 13th, 2023, for primary literature reporting seizure outcomes in >3 patients with HME receiving AH or FH. Demographics, neurophysiology findings, and Engel outcome at the last follow-up were extracted. Postsurgical seizure outcomes were compared through 2-tailed t -test and Fisher exact test. Univariate and multivariate Cox regression analyses were performed to identify independent predictors of Engel I outcome. RESULTS Data from 145 patients were extracted from 26 studies, of which 89 underwent FH (22 vertical, 33 lateral), 47 underwent AH, and 9 received an unspecified hemispherectomy with a median last follow-up of 44.0 months (FH cohort) and 45.0 months (AH cohort). Cohorts were similar in preoperative characteristics and at the last follow-up; 77% (n = 66) of the FH cohort and 81% (n = 38) and of the AH cohort were Engel I. On multivariate analysis, only the presence of bilateral ictal electroencephalography abnormalities (hazard ratio = 11.5; P = .002) was significantly associated with faster time-to-seizure recurrence. A number-needed-to-treat analysis to prevent 1 additional case of posthemispherectomy hydrocephalus reveals that FH, compared with AH, was 3. There was no statistical significance for any differences in time-to-seizure recurrence between lateral and vertical FH approaches (hazard ratio = 2.59; P = .101). CONCLUSION We show that hemispheric surgery is a highly effective treatment for HME-related DRE. Unilateral ictal electroencephalography changes and using the FH approach as initial surgical management may result in better outcomes due to significantly lower posthemispherectomy hydrocephalus probability. However, larger HME registries are needed to further delineate the predictors of seizure outcomes.
Collapse
Affiliation(s)
- Keshav Goel
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| | - Ashwin Ghadiyaram
- Virginia Commonwealth University School of Medicine, Richmond , Virginia , USA
| | - Asha Krishnakumar
- Virginia Commonwealth University School of Medicine, Richmond , Virginia , USA
| | - Frances T C Morden
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu , Hawaii , USA
| | - Tate J Higashihara
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu , Hawaii , USA
| | - William B Harris
- Department of Neurosurgery, University of Colorado, Boulder , Colorado , USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Andrew Wang
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| | - Krystal Karunungan
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| | - Anwesha Dubey
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| | - H Westley Phillips
- Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Alexander G Weil
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre, Montréal , Québec , Canada
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Centre (CHUM), Montréal , Québec , Canada
- Brain and Development Research Axis, Sainte-Justine Research Center, Montréal , Québec , Canada
- Department of Neuroscience, University of Montreal, Montréal , Québec , Canada
| | - Aria Fallah
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| |
Collapse
|
2
|
Kosugi K, Iijima K, Yokosako S, Takayama Y, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Sato N, Iwasaki M. Low EEG Gamma Entropy and Glucose Hypometabolism After Corpus Callosotomy Predicts Seizure Outcome After Subsequent Surgery. Front Neurol 2022; 13:831126. [PMID: 35401399 PMCID: PMC8989433 DOI: 10.3389/fneur.2022.831126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with generalized epilepsy who had lateralized EEG abnormalities after corpus callosotomy (CC) occasionally undergo subsequent surgeries to control intractable epilepsy.ObjectivesThis study evaluated retrospectively the combination of EEG multiscale entropy (MSE) and FDG-PET for identifying lateralization of the epileptogenic zone after CC.MethodsThis study included 14 patients with pharmacoresistant epilepsy who underwent curative epilepsy surgery after CC. Interictal scalp EEG and FDG-PET obtained after CC were investigated to determine (1) whether the MSE calculated from the EEG and FDG-PET findings was lateralized to the surgical side, and (2) whether the lateralization was associated with seizure outcomes.ResultsSeizure reduction rate was higher in patients with lateralized findings to the surgical side than those without (MSE: p < 0.05, FDG-PET: p < 0.05, both: p < 0.01). Seizure free rate was higher in patients with lateralized findings in both MSE and FDG-PET than in those without (p < 0.05).ConclusionsThis study demonstrated that patients with lateralization of MSE and FDG-PET to the surgical side had better seizure outcomes. The combination of MSE and conventional FDG-PET may help to select surgical candidates for additional surgery after CC with good postoperative seizure outcomes.
Collapse
Affiliation(s)
- Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
- *Correspondence: Masaki Iwasaki
| |
Collapse
|
3
|
Corpus Callosotomy in the Modern Era: Origins, Efficacy, Technical Variations, Complications, and Indications. World Neurosurg 2022; 159:146-155. [PMID: 35033693 DOI: 10.1016/j.wneu.2022.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 11/23/2022]
Abstract
Corpus callosotomy is among the oldest surgeries performed for drug-resistant epilepsy (DRE). First performed in 1940, various studies have since assessed its outcomes in various patient populations in addition to describing different extents of sectioning and emerging technologies (i.e. endoscopic, laser interstitial thermal therapy, and radiosurgery). In order to capture the current state and offer a reappraisal, we comprehensively review corpus callosotomy's origins, efficacy for various seizure types, technical variations, complications, and indications and compare the procedure to vagus nerve stimulation therapy which has similar indications. We consider corpus callosotomy to be a safe and efficacious procedure that should be considered by clinicians when appropriate. Furthermore, it can also play an important role in treating patients with DRE in low-to-middle-income countries where resources are limited.
Collapse
|
4
|
Yokosako S, Muraoka N, Watanabe S, Kosugi K, Takayama Y, Iijima K, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Iwasaki M. Corpus callosotomy in pediatric patients with non-lesional epileptic encephalopathy with electrical status epilepticus during sleep. Epilepsy Behav Rep 2021; 16:100463. [PMID: 34195590 PMCID: PMC8239855 DOI: 10.1016/j.ebr.2021.100463] [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: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022] Open
Abstract
Corpus callosotomy (CC) was performed in 3 pediatric patients with refractory epileptic encephalopathy with ESES. IQ was improved after CC with complete resolution of ESES in one patient. Developmental regression ceased after CC with worthwhile seizure reduction and temporary improvement of ESES in 2 patients. Epileptiform discharges disappeared or became lateralized after CC.
Epileptic encephalopathy with electrical status epilepticus during sleep (ESES) is often refractory to medical treatment and leads to poor cognitive outcomes. Corpus callosotomy may be an effective treatment option for drug-resistant ESES with no focal etiology. We retrospectively identified three patients who underwent corpus callosotomy for drug-resistant ESES in our institution. Electroencephalography (EEG) findings and cognitive functions were evaluated before surgery, at 3 months, 6 months, 1 year, and 2 years after surgery. Age at surgery was 6 years 10 months, 7 years 9 months, and 8 years 4 months, respectively. Period between the diagnosis of ESES and surgery ranged from 7 to 25 months. All patients had no obvious structural abnormalities and presented with cognitive decline despite multiple antiseizure medications and steroid therapies. One patient showed complete resolution of ESES and an improvement of intelligence quotient after surgery. Epileptiform EEG was lateralized to one hemisphere after surgery and spike wave index (SWI) was decreased with moderate improvement in development and seizures in the other 2 patients. SWI re-exacerbated from 6 months after surgery, but without subsequent developmental regression in these 2 patients. Corpus callosotomy may become an important treatment option for drug-resistant ESES in patients with no structural abnormalities.
Collapse
Affiliation(s)
- Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Norihiro Muraoka
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Shiena Watanabe
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Corresponding author.
| |
Collapse
|
5
|
Unterberger I, Bauer R, Walser G, Bauer G. Corpus callosum and epilepsies. Seizure 2016; 37:55-60. [DOI: 10.1016/j.seizure.2016.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/01/2016] [Accepted: 02/25/2016] [Indexed: 11/16/2022] Open
|
6
|
Kagawa K, Iida K, Hashizume A, Katagiri M, Baba S, Kurisu K, Otsubo H. Magnetoencephalography using gradient magnetic field topography (GMFT) can predict successful anterior corpus callosotomy in patients with drop attacks. Clin Neurophysiol 2016; 127:221-229. [DOI: 10.1016/j.clinph.2015.04.292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/21/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
|
7
|
Dimitriadis SI. Predictive value of MEG using gradient magnetic field topography (GMFT) for seizure outcome following anterior corpus callosotomy (ACC) in patients with drop attacks. Clin Neurophysiol 2015; 127:12-14. [PMID: 26168716 DOI: 10.1016/j.clinph.2015.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Stavros I Dimitriadis
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK; Cardiff University Brain Research Imaging Center (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK; Artificial Intelligence and Information Analysis Laboratory, Department of Informatics, Aristotle University, 54124 Thessaloniki, Greece; NeuroInformatics Group, AUTH, Thessaloniki, Greece.
| |
Collapse
|
8
|
Yang PF, Lin Q, Mei Z, Chen ZQ, Zhang HJ, Pei JS, Tian J, Jia YZ, Zhong ZH. Outcome after anterior callosal section that spares the splenium in pediatric patients with drop attacks. Epilepsy Behav 2014; 36:47-52. [PMID: 24857808 DOI: 10.1016/j.yebeh.2014.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
We report on the efficacy and safety of extended, one-stage anterior callosal section that spares the splenium, which is performed in a large series of pediatric patients with drop attacks. Twenty-nine pediatric patients with drop attacks were studied (19 males and 10 females; mean age: 9.9 years). As presurgical factors, the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, electroencephalograph abnormalities, magnetic resonance imaging abnormalities, and (18)fluorodeoxyglucose positron emission tomography abnormalities were analyzed. All patients had multiple seizure types, including drop attacks, atypical absence seizures, complex partial seizures, tonic seizures, and generalized tonic-clonic seizures. All patients were developmentally impaired and had electroencephalograph results showing marked secondary bilateral synchrony. All patients received an extended, one-stage callosal section, leaving only the splenium intact. The mean follow-up time was 5.2 years. Seizure outcome (cessation of seizures or ≥ 90% seizure reduction) was achieved in 79.3% of patients with drop attacks. The families assessed the overall daily function as improved in 62.1% of the patients, unchanged in 24.1%, and worse in 13.8%. Family satisfaction with callosotomy was achieved in 82.8% of the patients. The majority of the patients had some degree of a transient acute postoperative disconnection syndrome that disappeared within 3 weeks. Postoperatively, patients showed a consistent increase in attention levels. We conclude that extended callosal sectioning that leaves the splenium intact should be considered a good palliative surgical option for pediatric patients with drop attacks and that diminishment of epileptic discharge synchrony is a good prognostic sign following callosotomy. We also found that the postoperative increase in attention levels was as useful as seizure control in improving the quality of life of these patients.
Collapse
Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Qiao Lin
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhen Mei
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zi-Qian Chen
- Department of Medical Imaging, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Hui-Jian Zhang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jia-Sheng Pei
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jun Tian
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Yan-Zeng Jia
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhong-Hui Zhong
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| |
Collapse
|
9
|
Okumura E, Iwasaki M, Sakuraba R, Itabashi I, Osawa SI, Jin K, Itabashi H, Kato K, Kanno A, Tominaga T, Nakasato N. Time-varying inter-hemispheric coherence during corpus callosotomy. Clin Neurophysiol 2013; 124:2091-100. [DOI: 10.1016/j.clinph.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/28/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
|
10
|
VanStraten AF, Ng YT. Update on the management of Lennox-Gastaut syndrome. Pediatr Neurol 2012; 47:153-61. [PMID: 22883278 DOI: 10.1016/j.pediatrneurol.2012.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/09/2012] [Indexed: 11/26/2022]
Abstract
Lennox-Gastaut syndrome is a severe childhood epilepsy disorder characterized by encephalopathy and multiple, often intractable, seizure types. The drop attack is the most frequently recognizable seizure type in this patient population, and is also the most dangerous physically, thus severely limiting quality of life. The diagnosis is confirmed by electroencephalography, for which the classic pattern is a slow 2.5 Hz generalized spike-and-wave. Newer pharmacologic treatments include rufinimide and clobazam. However, antiepileptic drugs are often exhausted in pursuit of seizure control requiring nonpharmacologic interventions. These include dietary therapies, vagus nerve stimulation, and epilepsy surgery, including corpus callosotomy and focal curative resection. Although large lobar resections are often required, very localized, discrete resections may be possible, as in symptomatic Lennox-Gastaut syndrome (specifically, hypothalamic hamartoma). We review the history of the disease and current management options.
Collapse
Affiliation(s)
- Amanda F VanStraten
- Department of Neurology, University of Oklahoma Health Sciences Center, 711 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
| | | |
Collapse
|
11
|
Lin JH, Kwan SY. Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox–Gastaut syndrome. J Clin Neurosci 2012; 19:388-93. [DOI: 10.1016/j.jocn.2011.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 04/02/2011] [Indexed: 10/14/2022]
|
12
|
Jeong GU, Kim H, Lim BC, Chae JH, Kim KJ, Hwang YS, Hwang H. Predictive value of electroencephalography for seizure outcome following corpus callosotomy in children. J Epilepsy Res 2011; 1:65-70. [PMID: 24649448 PMCID: PMC3952332 DOI: 10.14581/jer.11012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 11/26/2011] [Indexed: 11/05/2022] Open
Abstract
Background and Purpose: This study aimed to determine whether preoperative or postoperative electroencephalography (EEG) can predict surgical outcome for corpus callosotomy. Methods: We retrospectively reviewed the medical records of 16 patients enrolled. We compared postoperative seizure outcome according to seizure type, preoperative interictal EEG, preoperative ictal EEG, and postoperative interictal EEG. Seizure outcome was classified according to postoperative seizure reduction, i.e., seizure free, >90%, 50–90%, <50%, and no change or worsened. A seizure reduction of 50% or more was judged as a “favorable outcome”. Results: Most patients showed a favorable outcome (12 patients, 75%) and two patients became seizure free (13%). Atonic seizure was most responsive to corpus callosotomy. Preoperative interictal epileptiform discharge had 3 patterns; bilateral independent, generalized, and combination of independent and generalized. None of the preoperative interictal epileptiform discharge (EDs) had significant correlation with seizure outcome. The preoperative ictal rhythm did not predict seizure outcome. However disappearance of generalized EDs on postoperative EEG was correlated with favorable seizure outcome. Conclusions: The presence of generalized EDs on postoperative interictal EEG predicted seizure outcome, whereas preoperative EEG did not.
Collapse
Affiliation(s)
- Go-Un Jeong
- Department of Pediatrics, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Yong Seung Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
13
|
Yonekawa T, Nakagawa E, Takeshita E, Inoue Y, Inagaki M, Kaga M, Sugai K, Sasaki M, Kaido T, Takahashi A, Otsuki T. Effect of corpus callosotomy on attention deficit and behavioral problems in pediatric patients with intractable epilepsy. Epilepsy Behav 2011; 22:697-704. [PMID: 21978470 DOI: 10.1016/j.yebeh.2011.08.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
Abstract
To evaluate the effect of corpus callosotomy (CC) on attention deficit and behavioral problems in pediatric patients with intractable epilepsy, we retrospectively investigated sequential patients who had undergone CC to control seizures. Between August 2005 and April 2010, a total of 15 patients aged between 3.1 and 17.9 years underwent CC at our institute. All the patients experienced either drop attacks or head nodding, which were considered to be therapeutic targets of CC. A standardized instrument, the Child Behavior Checklist (CBCL), was used to assess behavioral and emotional problems before and after surgery. On postoperative EEGs, 8 (53%) showed improvement and 7 (47%) showed no change in epileptiform discharges. The Attention Problems scale and total score on the CBCL significantly improved in patients whose postoperative EEGs showed improvement. In addition to amelioration of target seizures, CC can improve attention impairments in association with improvement in the postoperative EEG.
Collapse
Affiliation(s)
- Takahiro Yonekawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Iwasaki M, Nakasato N, Kakisaka Y, Kanno A, Uematsu M, Haginoya K, Tominaga T. Lateralization of interictal spikes after corpus callosotomy. Clin Neurophysiol 2011; 122:2121-7. [DOI: 10.1016/j.clinph.2011.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 04/14/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
|
15
|
Hur YJ, Kang HC, Kim DS, Choi SR, Kim HD, Lee JS. Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy. Brain Dev 2011; 33:672-7. [PMID: 21146944 DOI: 10.1016/j.braindev.2010.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/08/2010] [Accepted: 11/10/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Corpus callosotomy (CC) is a palliative surgical procedure to control atonic, tonic, or generalized tonic-clonic seizure in Lennox-Gastaut syndrome (LGS). Here, we report patients with LGS who underwent resective surgery, following CC better delineating the presumed seizure foci localized in one hemisphere. METHODS We retrospectively reviewed seven patients with LGS who underwent CC and subsequent cortical resection. The median follow-up duration after lobectomy was 20 months (range, 15-54 months) and three patients had follow-up periods over 24 months. The findings of video electroencephalography (EEG) monitoring, structural and functional neuroimagings were compared between pre- and post-CC. RESULTS Four patients had Engel class I and one patient had Engel class II outcomes following cortical resection; post-CC, compared to pre-CC, showed better localized ictal/interictal epileptiform discharges in the unilateral frontal area in two patients, in the unilateral parieto-temporo-occipital areas in one patient and in the unilateral fronto-temporal areas in the remaining two patients. Two patients had Engel Class III outcome following cortical resection; post-CC EEG continued to show multifocal epileptiform discharges but predominantly arising from a unilateral frontal area. Following CC, positron emission tomography showed localized glucose hypometabolism of which location was concordant with post-CC EEG abnormalities in all patient. Similarly, ictal/interictal single photon emission computed tomography also showed localized abnormalities concordant with post-CC EEG abnormalities in five of the six patients. Pathological assessment revealed cortical dysplasia in six patients, whereas no pathological abnormality was found in the remaining patient, who obtained Engel Class I outcome following cortical resection. CONCLUSION CC could change EEG findings, glucose metabolisms and cerebral blood flows, and it is sometimes helpful in delineating the primary seizure focus in patients with LGS.
Collapse
Affiliation(s)
- Yun Jung Hur
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea
| | | | | | | | | | | |
Collapse
|
16
|
Callosotomy and subsequent surgery for children with refractory epilepsy. Epilepsy Res 2011; 93:185-91. [DOI: 10.1016/j.eplepsyres.2010.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 12/15/2010] [Accepted: 12/21/2010] [Indexed: 11/29/2022]
|
17
|
Peltola ME, Liukkonen E, Granström ML, Paetau R, Kantola-Sorsa E, Valanne L, Falck B, Blomstedt G, Gaily E. The effect of surgery in encephalopathy with electrical status epilepticus during sleep. Epilepsia 2010; 52:602-9. [PMID: 21087244 DOI: 10.1111/j.1528-1167.2010.02783.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE We analyzed clinical and electroencephalography (EEG) outcomes of 13 patients with pharmacoresistant encephalopathy with electrical status epilepticus during sleep (ESES) following epilepsy surgery. METHODS All patients had symptomatic etiology of ESES and preoperative neuropsychological deterioration. Ten patients had daily atypical absences. Clinical outcome was assessed at 6 months and at 2 years after surgery. Clinical and EEG data were reviewed retrospectively. The spike propagation pattern and area and source strength in source montage were analyzed from preoperative and postoperative EEG studies. KEY FINDINGS Preoperative sleep EEG showed electrical status epilepticus during sleep (SES) with one-way interhemispheric propagation in nine patients and with two-way interhemispheric propagation in four. The age of the patients at the time of surgery ranged from 3.6-9.9 years. Focal resection (two patients) or hemispherotomy (one patient with postoperative EEG) either terminated SES or restricted the discharge to one region. Either reduced SES propagation area or source strength was found in four of eight callosotomy patients with postoperative EEG. Of patients who had seizures preoperatively, Engel class I-II seizure outcome was observed in two of three children after focal resection or hemispherotomy and in two of eight children after callosotomy. None of these patients with Engel class I-II outcome had SES with two-way interhemispheric propagation on preoperative EEG. Cognitive deterioration was halted postoperatively in all except one patient. Cognitive catch-up of more than 10 IQ points was seen in three patients, all of whom had shown a first measured IQ of >75. SIGNIFICANCE Patients with pharmacoresistant ESES based on symptomatic etiology may benefit from resective surgery or corpus callosotomy regarding both seizure outcome and cognitive prognosis.
Collapse
Affiliation(s)
- Maria E Peltola
- Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Prognostic Significance of Interictal Epileptiform Discharges After Epilepsy Surgery. J Clin Neurophysiol 2010; 27:255-62. [DOI: 10.1097/wnp.0b013e3181eaa5fa] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
19
|
Abstract
Lennox-Gastaut syndrome occurs in 3% of children with epilepsy and is characterized by multiple seizure types, slow spike-and-wave discharges and a poor prognosis for seizure control and cognitive development. Although randomized controlled trials of adjunctive felbamate, lamotrigine, topiramate and rufinamide have demonstrated a > or =50% reduction in seizure frequency, very few children achieve complete seizure control and a Cochrane review of the treatment of Lennox-Gastaut syndrome concluded that the optimum treatment was uncertain and that no drug has been shown to be highly efficacious. Valproate, lamotrigine and topiramate were considered recently by expert panels in the US and Europe to be the first-line drugs. The ketogenic diet may be more effective than antiepileptic drugs and should be considered early in treatment. An improvement in the management of Lennox-Gastaut syndrome requires a better understanding of the pathophysiology of this disorder and the development of animal models in which to test new compounds.
Collapse
Affiliation(s)
- Aspasia Michoulas
- Division of Neurology, Department of Pediatrics, University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
| | | |
Collapse
|
20
|
Electrocorticogram changes during corpus callosotomy for uncontrolled symptomatic generalized epilepsy. J Clin Neurosci 2010; 17:132-4. [DOI: 10.1016/j.jocn.2009.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 01/21/2009] [Accepted: 02/03/2009] [Indexed: 11/19/2022]
|
21
|
Cukiert A, Burattini JA, Cukiert CM, Argentoni-Baldochi M, Baise-Zung C, Forster CR, Mello VA. Centro-median stimulation yields additional seizure frequency and attention improvement in patients previously submitted to callosotomy. Seizure 2009; 18:588-92. [PMID: 19577937 DOI: 10.1016/j.seizure.2009.06.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 05/15/2009] [Accepted: 06/05/2009] [Indexed: 11/18/2022] Open
Abstract
RATIONALE Deep brain stimulation (DBS) has been increasingly used in the treatment of refractory epilepsy over the last decade. We report on the outcome after thalamic centro-median (CM) DBS in patients with generalized epilepsy who had been previously treated with extended callosal section. METHODS Four consecutive patients with generalized epilepsy who were previously submitted to callosal section and had at least 1 year of follow-up after deep brain implantation were studied. Age ranged from 19 to 44 years. All patients were submitted to bilateral CM thalamic DBS. Post-operative CT scans documented the electrode position in all patients. All patients had pre- and post-stimulation prolonged interictal scalp EEG recordings, including spike counts. Attention level was evaluated by means of the SNAP-IV questionnaire. The pre-implantation anti-epileptic drug regimen was maintained post-operatively in all patients. RESULTS Post-operative CT documented that all electrodes were correctly located. There was no morbidity or mortality. Seizure frequency reduction ranging from 65 to 95% and increased attention level was seen in all patients. Interictal spiking frequency was reduced from 25 to 95%, but their morphology remained the same. There was re-synchronization of interictal discharges during slow-wave sleep in 2 patients. CONCLUSION All patients benefit from the procedure. The CM seems to play a role in modulating the epileptic discharges and attention in these patients. On the other hand, it is not the generator of the epileptic abnormality and appeared not to be involved in non-REM sleep-related interictal spiking modulation.
Collapse
Affiliation(s)
- Arthur Cukiert
- Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, SP, Brazil.
| | | | | | | | | | | | | |
Collapse
|
22
|
Tanriverdi T, Ajlan A, Poulin N, Olivier A. Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution. J Neurosurg 2009; 110:1111-23. [DOI: 10.3171/2009.8.jns08338] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this paper the authors aimed to provide information related to major and minor surgical and neurological complications encountered following stereoelectroencephalography and epilepsy surgery.
Methods
The authors performed a retrospective review of 491 and 1905 patients who underwent intracranial electrode implantation and epilepsy surgery, respectively, between 1976 and 2006 at the Montreal Neurological Institute. All intracranial electrode implantations and surgical procedures were performed by 1 surgeon (A.O.).
Results
A total of 6415 electrode implantations and 2449 surgical procedures were done. There were no deaths related to either procedure. There were no major complications after intracranial electrode implantation, and the risks of infection and intracranial hematoma were found to be 1.8 and 0.8%, respectively. The number of electrodes per lobe (p = 0.05) and number of lobes covered (p = 0.04) were significant risk factors for hematoma and infection. Regarding epilepsy surgery, there were no major surgical complications, and the overall minor complication rate was 2.9%. Infection was the most common complication (1.0%), followed by intracranial hematoma (0.7%). Significant risk factors associated with hematomas and infections were the number of reoperations (p = 0.001) and older patient age (p = 0.03). Minor and major neurological complication rates were 2.7 and 0.5%, respectively, and the rate of overall neurological morbidity was 3.3%. Hemiparesis was the most frequent neurological complication (1.5%).
Conclusions
Based on the authors' experience, intracranial electrode implantation is an effective method with an extremely low morbidity rate. Moreover, epilepsy surgery is safe, especially in experienced hands.
Collapse
|
23
|
Nakayama T, Otsuki T, Kaneko Y, Nakama H, Kaido T, Otsubo H, Nakagawa E, Sasaki M, Sugai K. Repeat magnetoencephalography and surgeries to eliminate atonic seizures of non-lesional frontal lobe epilepsy. Epilepsy Res 2009; 84:263-7. [DOI: 10.1016/j.eplepsyres.2009.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 12/23/2008] [Accepted: 02/01/2009] [Indexed: 12/01/2022]
|
24
|
Tanriverdi T, Olivier A, Poulin N, Andermann F, Dubeau F. Long-term seizure outcome after corpus callosotomy: a retrospective analysis of 95 patients. J Neurosurg 2009; 110:332-42. [DOI: 10.3171/2008.3.17570] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors report long-term follow-up seizure outcome in patients who underwent corpus callosotomy during the period 1981–2001 at the Montreal Neurological Institute.
Methods
The records of 95 patients with a minimum follow-up of 5 years (mean 17.2 years) were retrospectively evaluated with respect to seizure, medication outcomes, and prognostic factors on seizure outcome.
Results
All patients had more than one type of seizure, most frequently drop attacks and generalized tonicclonic seizures. The most disabling seizure type was drop attacks, followed by generalized tonic-clonic seizures. Improvement was noted in several seizure types and was most likely for generalized tonic-clonic seizures (77.3%) and drop attacks (77.2%). Simple partial, generalized tonic, and myoclonic seizures also benefited from anterior callosotomy. The extent of the callosal section was correlated with favorable seizure outcome. The complications were mild and transient and no death was seen.
Conclusions
This study confirms that anterior callosotomy is an effective treatment in intractable generalized seizures that are not amenable to focal resection. When considering this procedure, the treating physician must thoroughly assess the expected benefits, limitations, likelihood of residual seizures, and the risks, and explain them to the patient, his or her family, and other caregivers.
Collapse
Affiliation(s)
| | | | | | - Frederick Andermann
- 2Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- 2Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
25
|
Hemispheric asymmetry of callosal neuronal participation in bilaterally synchronous epileptiform discharges. Seizure 2009; 18:7-13. [DOI: 10.1016/j.seizure.2008.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 05/09/2008] [Indexed: 11/20/2022] Open
|
26
|
Cukiert A, Burattini JA, Mariani PP, Cukiert CM, Argentoni-Baldochi M, Baise-Zung C, Forster CR, Mello VA. Outcome after extended callosal section in patients with primary idiopathic generalized epilepsy. Epilepsia 2008; 50:1377-80. [PMID: 19054399 DOI: 10.1111/j.1528-1167.2008.01875.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We report the outcome of patients with refractory idiopathic generalized epilepsy (IGE) who were submitted to extended one-stage callosal section. METHODS Eleven patients with IGE who were submitted to extended one-stage callosal section were studied. Preoperative workup included history and neurologic examination, interictal, and ictal electroencephalography (EEG) recording, high resolution 1.5T magnetic resonance imaging (MRI) and intelligence quotient (IQ) testing. All patients were submitted to extended one-stage microsurgical callosal section, leaving only the splenium intact. RESULTS Preoperative ictal patterns included repetitive spike and wave or polyspike and wave discharges or fast epileptic recruiting rhythm. MRI showed no focal lesions. Preoperatively, mean general IQ was 85. Postoperatively, at least a 75% reduction in the frequency of generalized tonic-clonic seizures was noted in all patients. In three patients absences disappeared completely, and the others had at least 90% reduction in seizure frequency. Only one patient had myoclonic seizures preoperatively, and these seizures disappeared after callosal section. After surgery, mean general IQ was 89. A very clear increase in attention level was noted in all patients. Postoperative interictal EEG recordings showed rupture of bilateral synchrony in all patients. DISCUSSION This article reports on a large and homogeneous series of patients with refractory IGE submitted for callosal section. There was a marked decrease in generalized seizure frequency and increase in the attention level in this patient population. Our results suggest that corticocortical interaction might have a role in IGE pathogenesis. Callosotomy is a safe, effective, and underused palliative procedure in these well-selected patients with refractory IGE.
Collapse
Affiliation(s)
- Arthur Cukiert
- Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Feichtinger M, Schröttner O, Eder H, Holthausen H, Pieper T, Unger F, Holl A, Gruber L, Körner E, Trinka E, Fazekas F, Ott E. Efficacy and Safety of Radiosurgical Callosotomy: A Retrospective Analysis. Epilepsia 2006; 47:1184-91. [PMID: 16886982 DOI: 10.1111/j.1528-1167.2006.00592.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Anterior callosotomy is a surgical option for the treatment of generalized tonic or atonic seizures associated with drop attacks. Besides open surgery, a radiosurgical callosal disconnection using the gamma knife (GK) also can be performed, but reliable data about tolerability and efficacy are sparse. METHODS Eight patients (three female, five male age range, 5 to 69 years) with severe generalized epilepsy associated with disabling drop attacks underwent GK callosotomy between 1993 and 2004. In six patients, the anterior third of the corpus callosum was radiosurgically disconnected. In one patient a second procedure with GK treatment of the middle third of the corpus callosum was added 17 months later. In two patients posterior GK callosotomy had followed partial hemispherotomy. RESULTS Drop attacks (DAs) were completely abolished in three patients, and two patients had a marked DA seizure reduction of 60%. Two of four patients with additional generalized tonic-clonic seizures showed a reduction of 100%, and the remaining, a 50% and 60% decrease, respectively. Other seizure types responded less well to the radiosurgical treatment. In both patients with posterior GK callosotomy after hemispherotomy, partial seizures decreased. Beside transient headache in two patients, no immediate or long-term postradiosurgical side effects were observed. CONCLUSIONS Palliative radiosurgical callosotomy is an efficient and safe noninvasive alternative to the open procedure with comparable results. No signs of postradiosurgical side effects were noted within an up to 12-year posttreatment period.
Collapse
|
28
|
Salayev KA, Nakasato N, Ishitobi M, Shamoto H, Kanno A, Tominaga T, Iinuma K. Evaluation of Interhemispheric Time Difference by Magnetoencephalography Before and After Total Callosotomy-Two Case Reports-. Neurol Med Chir (Tokyo) 2006; 46:136-42. [PMID: 16565583 DOI: 10.2176/nmc.46.136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Interhemispheric time difference (ITD) measured by electroencephalography (EEG) and magnetoencephalography (MEG) was compared to seizure outcome after callosotomy. Two patients with frequent drop attacks underwent simultaneous EEG and MEG before and after total callosotomy. ITDs in 30 bilateral synchronized (BS) discharges were calculated independently by EEG and MEG. As minimum transcallosal conduction time was suggested to be approximately 20 msec, BS discharges were classified into five categories according to ITD and side: left- or right-leading long (300 to 80 msec), left- or right-leading moderate (80 to 20 msec), and negligible (<20 msec). In Case 1 before callosotomy, EEG detected 77% negligible and 23% right-leading moderate BS discharges, whereas MEG detected 30% and 63%, respectively. After callosotomy, drop attacks reduced remarkably and EEG and MEG detected no BS discharges. In Case 2 before callosotomy, EEG detected 77% negligible and 23% moderate BS discharges, whereas MEG detected 80% and 20%, respectively. After callosotomy, drop attacks recurred 2 months later and EEG and MEG detected left- and right-leading long BS discharges (63% by EEG and 56% by MEG). MEG detected a large number of BS discharges with moderate ITD before surgery in Case 1, suggesting that the transcallosal pathway was the main pathway for the synchronization, whereas the negligible ITD in Case 2 excludes transcallosal propagation. BS discharges with longer ITD after surgery in Case 2 suggest a persistent poly-synaptic non-transcallosal pathway. MEG with higher spatial resolution than EEG may provide surgical indications for callosotomy.
Collapse
Affiliation(s)
- Kamran Ali Salayev
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi
| | | | | | | | | | | | | |
Collapse
|
29
|
Matsuo A, Ono T, Baba H, Ono K. Callosal role in generation of epileptiform discharges: quantitative analysis of EEGs recorded in patients undergoing corpus callosotomy. Clin Neurophysiol 2004; 114:2165-71. [PMID: 14580615 DOI: 10.1016/s1388-2457(03)00234-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Corpus callosotomy tends to decrease seizure frequency and severity rather than transforming the seizure pattern from a generalized form into a lateralized or a partial one. The finding implies that bisection of the corpus callosum (CC) disrupts the epileptogenicity itself. In order to gain further insight into the possible role played by the CC in intractable generalized epilepsy, quantitative analyses of long-term EEGs were performed. METHODS Analyses were made of epileptiform discharges contained in the pre- and postoperative long-term EEGs in 7 patients who had an anterior callosotomy for intractable epilepsy. The duration, number, and amplitude of all epileptiform burst activities were measured and statistically analyzed. RESULTS After callosotomy, the total number of epileptiform burst activities, mean duration, and the total number of spike discharges decreased significantly. The two hemispheres could be divided into dominant and non-dominant ones as to the quantity of the residual epileptiform discharges. CONCLUSIONS Corpus callosotomy unevenly reduced preoperative epileptiform discharges in both hemispheres, suggesting a facilitatory role played by the callosal neurons that enables the asymmetrical epileptogenic susceptible state of the two hemispheres to develop bisynchronous and bisymmetrical epileptiform discharges. SIGNIFICANCE Corpus callosotomy decreased the quantity of the epileptiform discharges, suggesting the transhemispheric facilitation of seizure mechanisms.
Collapse
Affiliation(s)
- Atsuko Matsuo
- Division of Pediatrics, Nagasaki Municipal Hospital, Nagasaki, Japan
| | | | | | | |
Collapse
|
30
|
Ono T, Matsuo A, Baba H, Ono K. Is a cortical spike discharge "transferred" to the contralateral cortex via the corpus callosum?: An intraoperative observation of electrocorticogram and callosal compound action potentials. Epilepsia 2002; 43:1536-42. [PMID: 12460256 DOI: 10.1046/j.1528-1157.2002.13402.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE By means of the intraoperative electrophysiologic observation, we reevaluated the "transfer" theory that a transcallosal volley invoked by a cortical spike discharge in one hemisphere directly causes its contralateral counterpart via the corpus callosum (CC). METHODS Twenty-six patients who underwent corpus callosotomy were the subjects of this study. Intraoperatively, electrocorticograms from both hemispheres were simultaneously monitored with callosal compound action potentials (CCAPs) from the CC. Analysis was conducted on (a) the interhemispheric delay of bilaterally synchronous spike-and-wave discharges (BSSWs), and (b) the chronological relation between BSSWs and CCAPs. RESULTS The side of prior spike discharges was never fixed but was occasionally reversed. Interhemispheric delays between the BSSWs were not constant, regardless of direction, and fluctuated in all patients. Most of the interhemispheric delays were distributed within 20 ms with a mode of 0 ms. The waveform of the CCAP was characterized by slow-rising negative potential change that attained its peak after a cortical spike discharge. These findings were identical in all the patients regardless of whether the BSSWs were changed or unchanged after callosotomy. CONCLUSIONS If the "transfer" role of the CC is true, interhemispheric delays between BSSWs must be longer than interhemispheric axonal conduction time (about 20 ms), and a preceding cortical spike discharge must produce a CCAP and then a contralateral one in order of time. However, this hypothesis was not confirmed in the present study. We propose the interhemispheric recruitment of the epileptogenic state as a different role of the CC on epileptogenesis.
Collapse
MESH Headings
- Adolescent
- Adult
- Cerebral Cortex/physiopathology
- Cerebral Cortex/surgery
- Child
- Child, Preschool
- Corpus Callosum/physiology
- Corpus Callosum/surgery
- Dominance, Cerebral/physiology
- Electroencephalography
- Epilepsies, Myoclonic/diagnosis
- Epilepsies, Myoclonic/physiopathology
- Epilepsies, Myoclonic/surgery
- Epilepsies, Partial/diagnosis
- Epilepsies, Partial/physiopathology
- Epilepsies, Partial/surgery
- Epilepsy, Generalized/diagnosis
- Epilepsy, Generalized/physiopathology
- Epilepsy, Generalized/surgery
- Evoked Potentials/physiology
- Female
- Humans
- Male
- Middle Aged
- Monitoring, Intraoperative
- Synaptic Transmission/physiology
Collapse
Affiliation(s)
- Tomonori Ono
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
| | | | | | | |
Collapse
|
31
|
Matsuzaka T, Ono K, Baba H, Matsuo M, Tanaka S, Kamimura N, Tsuji Y. Quantitative EEG analyses and surgical outcome after corpus callosotomy. Epilepsia 1999; 40:1269-78. [PMID: 10487191 DOI: 10.1111/j.1528-1157.1999.tb00857.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To clarify the relation between quantitative electroencephalogram (EEG) findings and outcome following corpus callosotomy (CC). METHODS The degree of bilateral synchrony and morphologic similarity of spike-wave discharges was analyzed by using a cross-correlation analysis and the measurements of amplitude differences between bilateral homologous regions in 22 patients who underwent anterior CCs for intractable symptomatic generalized epilepsies (SGE; 17 patients) and frontal lobe epilepsy (five patients). RESULTS Interictal generalized synchronous spike-wave (GSSW) bursts in the SGE patients were disrupted and changed to unilateral spike-waves (USWs) in 11 patients and to bilaterally independent spike-waves (BISWs) in six. The USW group had better surgical outcome than the BISW group. Preoperatively, the USW group had significantly lower interhemispheric synchrony (IS) and fewer regional changes in the side leading in time and the side dominant for amplitude, suggesting unilaterally predominant epileptogenesis that triggered the secondary bilateral synchrony. Postoperatively, the BISW group had a more marked reduction in IS because of independent discharges from bilateral epileptogenic areas, and the USW group had a greater amplitude difference because of unilateralized spike-waves. In addition, an excellent surgical outcome was related to (a) the preoperative degree of the morphologic similarity of the bilateral spike-waves (only a small variation during a burst of spike-waves) and the few instances of regional changes in the side leading in time and in the side dominant for amplitude; and (b) to large postoperative amplitude differences. CONCLUSION Preoperative quantitative EEG analyses enabled us to predict the underlying conditions of epileptogenesis and the surgical outcomes in patients undergoing CC.
Collapse
Affiliation(s)
- T Matsuzaka
- Department of Pediatrics, Nagasaki University School of Medicine, Sakamoto, Japan.
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
The objective of this review is a summary of the clinical and electrographic findings in those forms of epilepsy to which the term 'extratemporal' (ExT) can be applied. They form a group that differs in many ways from the better known temporal lobe epilepsies. Seizure foci are difficult to localize by clinical semiology alone but modern imaging now often allows a precise definition of the epileptogenic area. The most common causes of ExT epilepsy are tumors and cortical dysgenesis. The concept of 'dual pathology' implies the coexistence of two or more distinct lesions, typically mesial temporal sclerosis and cortical dysplasia. Electroencephalography (EEG) and electrocorticography (ECoG) are valuable tests in the definition of the epileptogenic area beyond the structural lesion, and surgical removal must be guided by the nature of the lesion and the extent of the epileptogenic zone.
Collapse
Affiliation(s)
- R L Kutsy
- University of Washington/Harborview Medical Center, Seattle 98104, USA.
| |
Collapse
|
33
|
Matsuo M, Matsuzaka T, Ono K, Baba H, Tanaka S, Kamimura N, Tsuji Y. Regional variation in bilateral synchrony of spike-wave discharge before and after corpus callosotomy. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0896-6974(98)00013-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Ishibashi H, Morioka T, Shigeto H, Yamamoto T, Nishio S, Fukui M. Magnetoencephalographic evaluation of anterior corpus callosotomy for intractable epilepsy in a patient with lennox-gastaut syndrome. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0896-6974(98)00018-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Kubota F, Shibata N, Shiihara Y, Takahashi S, Ohsuka T. Frontal lobe epilepsy with secondarily generalized 3 Hz spike-waves: a case report. CLINICAL EEG (ELECTROENCEPHALOGRAPHY) 1997; 28:166-71. [PMID: 9241471 DOI: 10.1177/155005949702800309] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a case of frontal lobe epilepsy with bursts of 3 Hz spike-wave, often dominant in the left frontal lobe, that sometimes developed into a secondary bilateral generalization. This patient was a 69-year-old male with a history of epileptic seizures that began 3 months following a head injury at the age of 17. His seizures occurred two or three times a day, but after medication the frequency was halved. The seizures began with a feeling of heaviness of the head, accompanied by myoclonus at both angles of the mouth. Consciousness was clear for most of the seizures, which ranged from several seconds to many minutes. When seizures lasted for longer than 10 minutes, a temporary generalization accompanied by a loss of consciousness was sometimes observed. Neurological tests and cranial MRI yielded no abnormal local findings. The secondary generalized seizure seen in this case is the so called "secondary bilateral synchrony (SBS)." We succeeded in making an EEG recording of the bilateral generalization of a seizure discharge originating in the left frontal lobe, which until now has not been done. This case is direct proof that a primary frontal focus can give rise to SBS.
Collapse
MESH Headings
- Aged
- Cortical Synchronization
- Dominance, Cerebral/physiology
- Electroencephalography
- Epilepsies, Partial/diagnosis
- Epilepsies, Partial/genetics
- Epilepsies, Partial/physiopathology
- Epilepsy, Absence/diagnosis
- Epilepsy, Absence/physiopathology
- Epilepsy, Frontal Lobe/diagnosis
- Epilepsy, Frontal Lobe/genetics
- Epilepsy, Frontal Lobe/physiopathology
- Epilepsy, Post-Traumatic/diagnosis
- Epilepsy, Post-Traumatic/physiopathology
- Evoked Potentials/physiology
- Frontal Lobe/physiopathology
- Humans
- Male
Collapse
Affiliation(s)
- F Kubota
- Department of Neuropsychiatry, Gunma University School of Medicine, Japan
| | | | | | | | | |
Collapse
|
36
|
Abstract
Secondary epileptogenesis as it applies to humans remains a controversial topic despite 40 years of investigation. Part of the controversy stems from disagreement about the definition of secondary epileptogenesis, and part of the controversy stems from the imperfect fit of animal models to the human epileptic syndromes. It may be that models of secondary epileptogenesis can be useful to describe specific epileptic syndromes such as bitemporal epilepsy and secondary bilateral synchrony, but other models may be required for remitting syndromes such as the Landau-Kleffner syndrome. The concept of secondary epileptogenesis may also provide a useful construct for evaluating patients with partial epileptic syndromes, especially those under consideration for epilepsy surgery, and for the evaluation of preventive strategies in epilepsy.
Collapse
Affiliation(s)
- J E Cibula
- Department of Neurology, University of Florida, Gainesville 32610-0236, USA
| | | |
Collapse
|
37
|
Rossi GF, Colicchio G, Marchese E, Pompucci A. Callosotomy for severe epilepsies with generalized seizures: outcome and prognostic factors. Acta Neurochir (Wien) 1996; 138:221-7. [PMID: 8686549 DOI: 10.1007/bf01411365] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of the present study was to verify the effect of callosotomy on generalized seizures, to check the effect on other seizure types and to search for possible prognostic factors. Twenty patients with a minimum follow-up of one year (mean 3.5 years) were available for our analysis. In six of them the callosotomy was performed in two stages (total: 26 surgical procedures). Age ranged from 14 to 40 years (mean 23 years). Different aetiologies were known in 15 patients. Duration of epilepsy ranged from 6 to 23 years (mean 15 years). The frequency of seizures ranged between 19 and 750 per month. The most significant effect of surgery was the complete suppression of the generalized seizures associated with falling in 9/19 and their reduction of more than 80% in 7/19 patients (total "good results": 16/19). The generalized tonic-clonic seizures were less affected. The surgical effect on the partial seizures was very variable, the partial simple seizures being the most affected. A positive statistical association with the outcome of the generalized seizures with fall was found for a presurgical seizure frequency below 90 per month, a prevalent bilateral EEG epileptic activity and, to a less extent, the absence of cerebral structural lesions. The role of age, aetiology, duration of the disease, single or more seizure types, mental impairment and extent of callosotomy remains uncertain. Disconnection syndrome does not appear if the splenium is spared. The present findings confirm that the main indication for callosotomy is the occurrence of generalized seizures with fall. Surgery can be initially limited to the anterior 2/3 of the corpus callosum; further posterior section of the corpus, excluding the splenium, should be regarded as a second step, when necessary.
Collapse
Affiliation(s)
- G F Rossi
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | | | | | | |
Collapse
|