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Wang S, Liu C, Zhang H, Liu Q, Ji T, Zhu Y, Fan Y, Yu H, Yu G, Wang W, Wang D, Cai L, Liu X. Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes. Front Neurol 2022; 13:922778. [PMID: 35937064 PMCID: PMC9353030 DOI: 10.3389/fneur.2022.922778] [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: 04/18/2022] [Accepted: 06/20/2022] [Indexed: 12/05/2022] Open
Abstract
To analyze the influence of seizure semiology, electroencephalography (EEG) features and magnetic resonance imaging (MRI) change on epileptogenic zone localization and surgical prognosis in children with epileptic spasm (ES) were assessed. Data from 127 patients with medically intractable epilepsy with ES who underwent surgical treatment were retrospectively analyzed. ES semiology was classified as non-lateralized, bilateral asymmetric, and focal. Interictal epileptiform discharges were divided into diffusive or multifocal, unilateral, and focal. MRI results showed visible local lesions for all patients, while the anatomo-electrical-clinical value of localization of the epileptogenic zone was dependent on the surgical outcome. During preoperative video EEG monitoring, among all 127 cases, 53 cases (41.7%) had ES only, 46 (36.2%) had ES and focal seizures, 17 (13.4%) had ES and generalized seizures, and 11 (8.7%) had ES with focal and generalized seizures. Notably, 35 (27.6%) and 92 cases (72.4%) showed simple and complex ES, respectively. Interictal EEG showed that 22 cases (17.3%) had bilateral multifocal discharges or hypsarrhythmia, 25 (19.7%) had unilateral dominant discharges, and 80 (63.0%) had definite focal or regional discharges. Ictal discharges were generalized/bilateral in 71 cases (55.9%) and definite/lateralized in 56 cases (44.1%). Surgically resected lesions were in the hemisphere (28.3%), frontal lobe (24.4%), temporal lobe (16.5%), temporo-parieto-occipital region (14.2%), and posterior cortex region (8.7%). Seizure-free rates at 1 and 4 years postoperatively were 81.8 and 72.7%, respectively. There was no significant difference between electroclinical characteristics of ES and seizure-free rate. Surgical treatment showed good outcomes in most patients in this cohort. Semiology and ictal EEG change of ES had no effect on localization, while focal or lateralized epileptiform discharges of interictal EEG may affect lateralization and localization. Complete resection of epileptogenic lesions identified via MRI was the only factor associated with a positive surgical outcome.
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Affiliation(s)
- Shuang Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chang Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Hongwei Zhang
- Department of Neurology, Qilu Children's Hospital of Shandong University, Shandong, China
| | - Qingzhu Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Taoyun Ji
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Zhu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yan Fan
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Hao Yu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Guojing Yu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Wen Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Dongming Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Lixin Cai
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
- Lixin Cai
| | - Xiaoyan Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- *Correspondence: Xiaoyan Liu
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Balestrini S, Guerrini R, Sisodiya SM. Rare and Complex Epilepsies from Childhood to Adulthood: Requirements for Separate Management or Scope for a Lifespan Holistic Approach? Curr Neurol Neurosci Rep 2021; 21:65. [PMID: 34817708 PMCID: PMC8613076 DOI: 10.1007/s11910-021-01154-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In this descriptive review, we describe current models of transition in rare and complex epilepsy syndromes and propose alternative approaches for more holistic management based on disease biology. RECENT FINDINGS Previously published guidance and recommendations on transition strategies in individuals with epilepsy have not been systematically and uniformly applied. There is significant heterogeneity in models of transition/transfer of care across countries and even within the same country. We provide examples of the most severe epilepsy and related syndromes and emphasise the limited data on their outcome in adulthood. Rare and complex epilepsy syndromes have unique presentations and require high levels of expertise and multidisciplinary approach. Lifespan clinics, with no transition, but instead continuity of care from childhood to adulthood with highly specialised input from healthcare providers, may represent an alternative effective approach. Effectiveness should be measured by evaluation of quality of life for both patients and their families/caregivers.
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Affiliation(s)
- Simona Balestrini
- Department of Clinical and Experimental Epilepsy, University College of London (UCL) Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, London, Bucks, UK.
- Neuroscience Department, Meyer Children's Hospital, European Reference Network ERN EpiCARE, 50139, Florence, Italy.
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital, European Reference Network ERN EpiCARE, 50139, Florence, Italy
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, University College of London (UCL) Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, London, Bucks, UK
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Meiron O, Gale R, Namestnic J, Bennet-Back O, David J, Gebodh N, Adair D, Esmaeilpour Z, Bikson M. High-Definition transcranial direct current stimulation in early onset epileptic encephalopathy: a case study. Brain Inj 2017; 32:135-143. [PMID: 29156988 DOI: 10.1080/02699052.2017.1390254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PRIMARY OBJECTIVE Early onset epileptic encephalopathy is characterized by high daily seizure-frequency, multifocal epileptic discharges, severe psychomotor retardation, and death at infancy. Currently, there are no effective treatments to alleviate seizure frequency and high-voltage epileptic discharges in these catastrophic epilepsy cases. The current study examined the safety and feasibility of High-Definition transcranial direct current stimulation (HD-tDCS) in reducing epileptiform activity in a 30-month-old child suffering from early onset epileptic encephalopathy. DESIGN AND METHODS HD-tDCS was administered over 10 intervention days spanning two weeks including pre- and post-intervention video-EEG monitoring. RESULTS There were no serious adverse events or side effects related to the HD-tDCS intervention. Frequency of clinical seizures was not significantly reduced. However, interictal sharp wave amplitudes were significantly lower during the post-intervention period versus baseline. Vital signs and blood biochemistry remained stable throughout the entire study. CONCLUSIONS These exploratory findings support the safety and feasibility of 4 × 1 HD-tDCS in early onset epileptic encephalopathy and provide the first evidence of HD-tDCS effects on paroxysmal EEG features in electroclinical cases under the age of 36 months. Extending HD-tDCS treatment may enhance electrographic findings and clinical effects.
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Affiliation(s)
- Oded Meiron
- a Clinical Research Center for Brain Sciences , Herzog Medical Center , Jerusalem , Israel
| | - Rena Gale
- b Children Respiratory Unit , Herzog Medical Center , Jerusalem , Israel
| | - Julia Namestnic
- b Children Respiratory Unit , Herzog Medical Center , Jerusalem , Israel
| | - Odeya Bennet-Back
- c Pediatric Neurology Department , Shaare Zedek Medical Center , Jerusalem , Israel
| | - Jonathan David
- a Clinical Research Center for Brain Sciences , Herzog Medical Center , Jerusalem , Israel
| | - Nigel Gebodh
- d Department of Biomedical Engineering , The City College of the City University of New York , New York , USA
| | - Devin Adair
- d Department of Biomedical Engineering , The City College of the City University of New York , New York , USA
| | - Zeinab Esmaeilpour
- d Department of Biomedical Engineering , The City College of the City University of New York , New York , USA.,e Biomedical Engineering Department , Amirkabir University of Technology , Tehran , Iran
| | - Marom Bikson
- d Department of Biomedical Engineering , The City College of the City University of New York , New York , USA
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