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Alawadhi A, Appendino JP, Hader W, Rosenblatt B, Moreau JT, Dubeau F, Dudley RWR, Myers KA. Surgically Remediable Secondary Network Epileptic Encephalopathies With Continuous Spike Wave in Sleep: Lesions May Not Be Visible on Brain Magnetic Resonance Imaging (MRI). J Child Neurol 2022; 37:992-1002. [PMID: 36184927 DOI: 10.1177/08830738221129919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Continuous spike wave in sleep (CSWS) is an electroencephalogram (EEG) pattern associated with developmental and epileptic encephalopathy with spike-and-wave activation in sleep (DEE-SWAS). This etiologically heterogeneous syndrome may occur because of genetic factors and congenital or acquired brain lesions. We studied the pattern of clinical presentation and underlying etiologies in patients with DEE-SWAS that respond to resective surgery. METHODS We reviewed our clinical and research databases for patients who had resolution of CSWS following surgical resection of a focal lesion. RESULTS We identified 5 patients meeting inclusion criteria. In 3 of 5, an epileptogenic structural abnormality was not apparent on brain magnetic resonance imaging (MRI). In all 3 patients, focal cortical dysplasia was identified through intracranial EEG monitoring. SIGNIFICANCE DEE-SWAS may be a secondary bilateral network epilepsy syndrome, which can be treated with resection of the inciting focal lesion. In patients with drug-resistant CSWS, clinicians should consider a complete epilepsy presurgical workup, including intracranial EEG monitoring.
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Affiliation(s)
- Abdulla Alawadhi
- Division of Child Neurology, Department of Pediatrics, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada.,Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.,Dubai Health Authority, Dubai, United Arab Emirates
| | - Juan Pablo Appendino
- Section of Neurology, Department of Pediatrics, 9978Alberta Children's Hospital, Cumming School of Medicine, 70401University of Calgary, Calgary, Alberta, Canada
| | - Walter Hader
- Department of Clinical Neuroscience, Cumming School of Medicine, 70401University of Calgary, Calgary, Alberta, Canada
| | - Bernard Rosenblatt
- Division of Child Neurology, Department of Pediatrics, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada
| | - Jeremy T Moreau
- Cumming School of Medicine, 70401University of Calgary, Calgary, Alberta, Canada
| | - Francois Dubeau
- Department of Neurology & Neurosurgery, 55981Montreal Neurological Hospital, 5620McGill University, Montreal, Quebec, Canada
| | - Roy W R Dudley
- Department of Neurology & Neurosurgery, 55981Montreal Neurological Hospital, 5620McGill University, Montreal, Quebec, Canada.,Department of Neurology & Neurosurgery, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada.,5620Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kenneth A Myers
- Division of Child Neurology, Department of Pediatrics, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada.,Department of Neurology & Neurosurgery, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada.,5620Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Romero-Osorio Ó, Gil-Tamayo S, Nariño D, Rosselli D. Changes in sleep patterns after vagus nerve stimulation, deep brain stimulation or epilepsy surgery: Systematic review of the literature. Seizure 2018; 56:4-8. [PMID: 29414594 DOI: 10.1016/j.seizure.2018.01.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/23/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Perform a systematic review of the literature on the effects of vagus nerve stimulation (VNS), deep brain stimulation (DBS) and epilepsy surgery in subjective and objective sleep parameters. METHODS We performed a literature search in the main medical databases: Medline, Embase, Cochrane, DARE and LILACS, looking for studies that evaluated the effects of VNS, DBS or epilepsy surgery on sleep parameters. In all, 36 studies, coming from 11 countries, including reviews, cohort studies, case series and case reports were included. RESULTS VNS induces sleep apnoea dependent of the stimulation variables. This condition can be reverted modifying these settings. Surgical procedures for epilepsy cause an improvement in objective and subjective sleep parameters that depend on the success of the procedure evaluated through ictal frequency control. There is evidence that non-pharmacologic treatment of epilepsy has different effects on sleep patterns. CONCLUSION It is advisable to include objective and subjective sleep parameters in the initial evaluation and follow-up of patients considered for invasive procedures for epilepsy control, especially with VNS due to the risk of sleep apnoea. More high quality studies are needed.
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Affiliation(s)
- Óscar Romero-Osorio
- Neurosciences Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
| | | | - Daniel Nariño
- Neurosciences Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
| | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
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Neuropsychological outcomes following paediatric temporal lobe surgery for epilepsies: Evidence from a systematic review. Seizure 2017; 52:89-116. [PMID: 29032016 DOI: 10.1016/j.seizure.2017.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/24/2017] [Accepted: 09/06/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The systematic review aimed to assess the neuropsychological outcomes of temporal lobe resections for epilepsy in children. Additional objectives included determining whether earlier age at surgery leads to better neuropsychological outcomes; the relationships between and predictors of these outcomes. METHODS Using advanced search terms, a systematic review of electronic databases was conducted, comprising MEDLINE, Embase, PsycINFO, Global Health, Web of Science and CINAHL. Included studies reported on outcome following neurosurgical treatment for epilepsy. Specifically, studies were included if they reported neuropsychological outcomes and were concerned only with temporal lobe resection. RESULTS 73 studies met inclusion criteria. For reported neuropsychological outcomes, the majority of participants remained stable after surgery; some declined and some improved. There was some evidence for increased material-specific memory deficits after temporal lobe surgery based on resection side, and more positive cognitive outcome for those with lower pre-surgical ability level. SIGNIFICANCE Retrieved evidence highlights the need for improvements to quality of methodology and reporting. Appropriately designed prospective multicentre trials should be conducted with adequate follow-up for long-term outcomes to be measured. Core outcome measures should be agreed between centres. This would permit higher quality evidence so that clinicians, young people and their families may make better informed decisions about whether or not to proceed with surgery and likely post-operative profile.
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Ladino LD, Gleadow A, Téllez-Zenteno JF. A unique ictal EEG pattern in a patient with the coexistence of generalized and focal epilepsy. Clin EEG Neurosci 2015; 46:136-41. [PMID: 24615929 DOI: 10.1177/1550059413516463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/19/2013] [Indexed: 11/15/2022]
Abstract
The coexistence of focal and generalized epilepsy is rare. We report on a 17-year-old male with drug-resistant focal epilepsy and idiopathic generalized epilepsy (IGE). He began to experience generalized tonic-clonic seizures (GTCS) at the age of 3 years, with a good response to phenobarbital. At the age of 14 years, he began to experience complex partial seizures (CPS). Video-electroencephalography (video-EEG) telemetry showed the coexistence of right temporal spikes and bursts of generalized spike-wave (GSW). The ictal EEG showed a unique EEG pattern characterized by a 4- to 5-second burst of GSW followed by rhythmic delta activity over the right temporal region. A magnetic resonance image (MRI) showed right hippocampal sclerosis. The patient underwent a right temporal lobectomy that significantly improved his seizure control. He was rendered seizure free of the complex partial seizures and improvement of the GTCS. This case illustrates a very uncommon ictal EEG pattern, and shows that the decision for surgery in patients with focal drug-resistant epilepsy should not be affected by coexistent generalized epilepsy.
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Affiliation(s)
- Lady Diana Ladino
- Neurology Department, Hospital Pablo Tobón Uribe, Medellin, Antioquia, Colombia
| | - Aaron Gleadow
- Clinical Neurophysiology Laboratory, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - José F Téllez-Zenteno
- Division of Neurology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Fine A, Nickels K. Temporoparietal resection in a patient with Landau-Kleffner syndrome. Semin Pediatr Neurol 2014; 21:96-100. [PMID: 25149936 DOI: 10.1016/j.spen.2014.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anthony Fine
- Department of Pediatrics, Mayo Clinic, Rochester, MN
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Continuous Spike-Wave during Slow Wave Sleep and Related Conditions. ISRN NEUROLOGY 2014; 2014:619079. [PMID: 24634784 PMCID: PMC3929187 DOI: 10.1155/2014/619079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/05/2013] [Indexed: 11/25/2022]
Abstract
Continuous spike and wave during slow wave sleep (CSWS) is an epileptic encephalopathy that presents with neurocognitive regression and clinical seizures, and that demonstrates an electroencephalogram (EEG) pattern of electrical status epilepticus during sleep, as defined by the Commission on Classification and Terminology of the International League Against Epilepsy 1989. CSWS is an age-related condition, typically presenting in children around 5 years of age, with clinical seizures which progress within 2 years to a severe epileptic encephalopathy. The pathophysiology of CSWS is not completely understood, but the corticothalamic neuronal network involved in sleep patterns is thought to be involved. Genetic predisposition and injury in early development are thought to play etiological roles. Treatment strategies have involved traditional anticonvulsants, hormonal therapies, and other newer techniques. Outcomes are fair, and the thought is that earlier diagnosis and intervention preserve neurocognitive development, as in the case of other epileptic encephalopathies. Further understanding of the mechanisms of CSWS may lead to improved therapeutic options and thus outcomes of children with CSWS.
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Matos G, Tufik S, Scorza FA, Cavalheiro EA, Andersen ML. Sleep and epilepsy: exploring an intriguing relationship with a translational approach. Epilepsy Behav 2013; 26:405-9. [PMID: 23394796 DOI: 10.1016/j.yebeh.2012.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/08/2012] [Indexed: 01/16/2023]
Abstract
The relationship between sleep and epilepsy has been well established. There is a high prevalence of sleep disturbances in epilepsy, which are associated with a decreased quality of life of individuals with epilepsy. In view of this fact, preclinical research is necessary to address many gaps in knowledge. For instance, it is well known that sleep deprivation can trigger seizures; however, this is a complex pathophysiological event. In this context, there are many valuable animal models of epilepsy that reproduce clinical symptoms and can be used. Investigations using animal models that simulate clinical epilepsy are imperative. Furthermore, preclinical studies that reveal mechanisms related to sleep-epilepsy interactions are very important. Results of such studies can, in turn, improve the understanding of epilepsy itself and can be useful in developing new antiepileptic drugs and preventive measures to control seizures. Preclinical research should be performed using a translational framework with experimental designs that can lead to advances in the quality of life of individuals with epilepsy. In view of the fact that more than 50 million of people are affected by epilepsy around the world, understanding the relationship between sleep and epilepsy is imperative.
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Affiliation(s)
- Gabriela Matos
- Departamento de Psicobiologia, Universidade Federal de São Paulo, SP, Brazil
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