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Epilepsy Surgery

W Wang, F Lian, Y J Fu, D H Lu, L H Zhao, L F Wei, Y S Piao
Objective: To investigate the clinicpathologic features and probable mechanisms of massive subcortical heterotopia. Methods: Clinical data, histologic features and neuropathologic data were analyzed in five cases of massive subcortical heterotopia collected from Xuanwu Hospital, Capital Medical University from January 2014 to October 2017. Results: All five patients (three males and two females) had a history of refractory epilepsy with a mean period of 15.4 years (range 7 to 21 years). The median age at surgery was 28...
September 8, 2018: Zhonghua Bing Li Xue za Zhi Chinese Journal of Pathology
Nadine Conradi, Anke Hermsen, Kristina Krause, Iris Gorny, Adam Strzelczyk, Susanne Knake, Felix Rosenow
Since its introduction, functional transcranial Doppler sonography (fTCD) has been extensively applied in research and clinical settings and has now become part of the routine presurgical work-up of patients with epilepsy. Because of its importance in planning neurosurgical interventions and predicting possible cognitive risks, the reproducibility of fTCD in determining hemispheric language lateralization (HLL) has to be ensured. In the present study, fTCD was performed twice in 33 initially lateralized patients with temporal lobe epilepsy (TLE) as part of their presurgical work-up, using a standard word generation paradigm...
September 11, 2018: Epilepsy & Behavior: E&B
Sherif Elwan, Andreas Alexopoulos, Diosely C Silveira, Prakash Kotagal
PURPOSE: To evaluate the lateralizing and localizing value of seizure semiology in patients who became completely seizure free after resective epilepsy surgery. METHODS: We analyzed seizures of patients who were seizure free after focal resection limited to the temporal lobe (30 patients), frontal lobe (27 patients), parietal lobe (8 patients) and occipital lobe (8 patients). Three investigators independently analyzed video segments of seizures blinded to clinical information and attempted to lateralize and localize the seizure focus, based on pre-defined criteria...
September 5, 2018: Seizure: the Journal of the British Epilepsy Association
Le Zhang, Xin-Yue Jiang, Dong Zhou, Heng Zhang, Shi-Min Bao, Jin-Mei Li
This study aimed to investigate the impact of timing interval to start AED withdraw (TIW) after surgery on the seizure outcome in non-neoplastic drug resistant epilepsy (DRE). TIW were divided into three groups (respectively,<1 year, 1-<2 years, and ≥2 years). The seizure outcome at the different time points after starting AED withdrawal were compared among three groups. Other factors that related to seizure recurrence and TIW were included into the multiple analysis to investigate the predictors of seizure-free...
September 13, 2018: Scientific Reports
Viola L Vogt, Juri-Alexander Witt, Daniel Delev, Alexander Grote, Marec von Lehe, Albert J Becker, Johannes Schramm, Christian E Elger, Christoph Helmstaedter
OBJECTIVE: The objective of the study was to evaluate cognitive and epilepsy-related features in 166 surgically treated patients with epilepsy with long-term epilepsy-associated tumors (LEATs) located in the temporal lobe. METHOD: Pre- and postsurgical cognitive as well as the one-year seizure outcome of adult patients with histopathologically confirmed LEATs (28 grade-I dysembryoplastic neuroepithelial tumors (DNET), 95 grade-I gangliogliomas (GG), 24 grade-I pilocytic astrocytomas (PA), 9 grade-II pleomorphic xanthoastrocytoma (PXA), 10 grade-II diffuse astrocytoma (DA)) who underwent epilepsy surgery in Bonn/Germany between 1988 and 2012 were evaluated...
September 10, 2018: Epilepsy & Behavior: E&B
M Gómez-Eguílaz, J L Ramón-Trapero, L Pérez-Martínez, J R Blanco
Epilepsy is a neurological disease with high global prevalence. Despite the range of drug-based treatments currently available to control the condition, one in 3 patients experiences epileptic seizures. Therapeutic alternatives for these patients include the ketogenic diet, surgery or the cerebral implantation of neurostimulators; however these are benefits with limits. The target of this study is to find a new complementary treatment for these patients, studying the effectiveness of probiotics for controlling epileptic seizures in patients with drug-resistant epilepsy...
September 10, 2018: Beneficial Microbes
Amanda Kahn, Gurmeen Kaur, Laura Stein, Stanley Tuhrim, Mandip S Dhamoon
BACKGROUND: International trials suggest benefit of revascularization surgery (RS) for moyamoya disease (MMD). However, nationally representative US data on demographics and outcomes after RS in MMD are lacking. AIMS: To estimate causes and rates of readmission after RS for MMD. METHODS: In the Nationwide Readmissions Database, index admissions for ECICB for MMD and readmissions for ischemic stroke (IS), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH) were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes...
September 8, 2018: Journal of Neurology
Joon Won Kang, Soyong Eom, William Hong, Hye Eun Kwon, Soyoung Park, Ara Ko, Hoon-Chul Kang, Joon Soo Lee, Young-Mock Lee, Dong Seok Kim, Heung Dong Kim
OBJECTIVE: We aimed to evaluate the long-term outcome of resective epilepsy surgery in patients with Lennox-Gastaut syndrome (LGS). METHODS: We reviewed the case reports of 90 patients with LGS who had undergone resective surgery between 2003 and 2014 at the Severance Children's Hospital and managed them for a minimum period of 2 years. RESULTS: At the time of surgery, the patients were between 3.0 and 23.5 years old (mean ± SD: 9.3 ± 4...
September 7, 2018: Pediatrics
Cuiping Xu, Tao Yu, Guojun Zhang, Yuping Wang, Yongjie Li
PURPOSE: We aimed to investigate the possible predictive factors and longitudinal change in long-term surgical outcome following refractory frontal lobe epilepsy (FLE) surgery. METHODS: We retrospectively reviewed 82 patients who underwent frontal lobe resection. Invasive monitoring was performed in 43 patients. All patients were followed up for a minimum of 3 years after surgery. univariate and multivariate analysis were used to evaluate the predictors. The Kaplan-Meier survival curve showed the estimated probability of complete seizure-freedom, and a favorable outcome was defined as Engel class I at the last follow-up...
September 3, 2018: World Neurosurgery
Ryan W Sever, Andrew C Vivas, Fernando L Vale, Mike R Schoenberg
Objective: This study reports neuropsychological outcomes based on preoperative Wada testing in patients with drug-resistant mesial temporal lobe epilepsy (mTLE). Methods: Patient records were retrospectively reviewed as part of a larger database. Patients with a diagnosis of TLE based on seizure semiology and long-term surface video-electroencephalography (EEG) were identified. These patients underwent preoperative and postoperative testing including advanced imaging (magnetic resonance imaging [MRI]), Wada testing, and neuropsychological assessment...
September 2018: Epilepsia open
Aura Silva, Pedro Amorim, Luiza Felix, Fernando Abelha, Joana Mourão
Background: Patients with intellectual disability (ID) often require general anesthesia during oral procedures. Anesthetic depth monitoring in these patients can be difficult due to their already altered mental state prior to anesthesia. In this study, the utility of electroencephalographic indexes to reflect anesthetic depth was evaluated in pediatric patients with ID. Methods: Seventeen patients (mean age, 9.6 ± 2.9 years) scheduled for dental procedures were enrolled in this study...
August 2018: Journal of Dental Anesthesia and Pain Medicine
Hiroto Iwasa, Reiko Hosaka, Sunao Kaneko
Psychiatric comorbidities, including mood, anxiety, psychotic disorders, and autism spectrum disorder are common in patients with epilepsy (PWE), often occurring at rates 2-3-fold or higher than in the general population without epilepsy. Furthermore, an attention should be paid to psychiatric symptoms together with those caused by antiepileptic drug therapy, epilepsy surgery, and vagus nerve stimulation because these therapies sometimes induce psychiatric comorbidities. It is important to differentiate psychogenic non epileptic seizures (PNES) from epilepsy, and to provide patients with psychiatric treatment...
September 2018: Brain and Nerve, Shinkei Kenkyū No Shinpo
Stefan L Sumsky, Sabato Santaniello
Interictal high frequency oscillations (HFO) are a promising biomarker that can help define the seizure onset zone (SOZ) and predict the surgical outcome after the epilepsy surgery. The utility of HFO in planning the surgery, though, is un-clear. Reasons include the variability of the HFO across patients and brain regions and the influence of the sleep-wake cycle, which causes large fluctuations in the ratio be-tween the HFO observed in SOZ and non-SOZ regions. To cope with these limitations, a rank-based solution is pro-posed to identify the SOZ by using the HFO in multi-channel intracranial EEG...
August 30, 2018: IEEE Journal of Biomedical and Health Informatics
Kevin Akeret, David Bellut, Hans-Jürgen Huppertz, Georgia Ramantani, Kristina König, Carlo Serra, Luca Regli, Niklaus Krayenbühl
OBJECTIVE Surgery has proven to be the best therapeutic option for drug-refractory cases of focal cortical dysplasia (FCD)-associated epilepsy. Seizure outcome primarily depends on the completeness of resection, rendering the intraoperative FCD identification and delineation particularly important. This study aims to assess the diagnostic yield of intraoperative ultrasound (IOUS) in surgery for FCD-associated drug-refractory epilepsy. METHODS The authors prospectively enrolled 15 consecutive patients with drug-refractory epilepsy who underwent an IOUS-assisted microsurgical resection of a radiologically suspected FCD between January 2013 and July 2016...
September 2018: Neurosurgical Focus
Jonathan Pindrik, Nguyen Hoang, Luke Smith, Mark Halverson, Mary Wojnaroski, Kelly McNally, Satyanarayana Gedela, Adam P Ostendorf
OBJECTIVE Despite perioperative risks, epilepsy surgery represents a legitimate curative or palliative treatment approach for children with drug-resistant epilepsy (DRE). Several factors characterizing infants and toddlers with DRE create unique challenges regarding optimal evaluation and management. Epilepsy surgery within children < 3 years of age has received moderate attention in the literature, including mainly case series and retrospective studies. This article presents a systematic literature review and explores multidisciplinary considerations for the preoperative evaluation and surgical management of infants and toddlers with DRE...
September 2018: Neurosurgical Focus
Kelsey Cobourn, Islam Fayed, Robert F Keating, Chima O Oluigbo
OBJECTIVE Stereoelectroencephalography (sEEG) and MR-guided laser interstitial thermal therapy (MRgLITT) have both emerged as minimally invasive alternatives to open surgery for the localization and treatment of medically refractory lesional epilepsy. Although some data are available about the use of these procedures individually, reports are almost nonexistent on their use in conjunction. The authors' aim was to report early outcomes regarding efficacy and safety of sEEG followed by MRgLITT for localization and ablation of seizure foci in the pediatric population with medically refractory lesional epilepsy...
September 2018: Neurosurgical Focus
Taylor J Abel, Emma Losito, George M Ibrahim, Eishi Asano, James T Rutka
Epileptic spasms (ES) are a common manifestation of intractable epilepsy in early life and can lead to devastating neurodevelopmental consequences. Epilepsy surgery for ES is challenging because of inherent difficulties in localizing the epileptogenic zone in affected infants and children. However, recent clinical series of resective neurosurgery for ES suggest that not only is surgery a viable option for appropriately selected patients, but postoperative seizure outcomes can be similar to those achieved in other types of focal epilepsy...
September 2018: Neurosurgical Focus
Zulma Tovar-Spinoza, Robert Ziechmann, Stephanie Zyck
OBJECTIVE Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment for the surgical treatment of epilepsy. In this paper, the authors report on clinical outcomes for a series of pediatric patients with tuberous sclerosis complex (TSC) and medication-refractory epileptogenic cortical tubers. METHODS A retrospective chart review was performed at SUNY Upstate Golisano Children's Hospital in Syracuse, New York. The authors included all cases involving pediatric patients (< 18 years) who underwent MRgLITT for ablation of epileptogenic cortical tubers between February 2013 and November 2015...
September 2018: Neurosurgical Focus
David Ahmedt-Aristizabal, Clinton Fookes, Simon Denman, Kien Nguyen, Tharindu Fernando, Sridha Sridharan, Sasha Dionisio
During seizures, a myriad of clinical manifestations may occur. The analysis of these signs, known as seizure semiology, gives clues to the underlying cerebral networks involved. When patients with drug-resistant epilepsy are monitored to assess their suitability for epilepsy surgery, semiology is a vital component to the presurgical evaluation. Specific patterns of facial movements, head motions, limb posturing and articulations, and hand and finger automatisms may be useful in distinguishing between mesial temporal lobe epilepsy (MTLE) and extratemporal lobe epilepsy (ETLE)...
August 30, 2018: Epilepsy & Behavior: E&B
Ryoko Umaba, Takehiro Uda, Kosuke Nakajo, Toshiyuki Kawashima, Yuta Tanoue, Saya Koh, Hiroshi Uda, Noritsugu Kunihiro, Yasuhiro Matsusaka, Kenji Ohata
BACKGROUND: Posterior quadrant disconnection (PQD) is a surgery for refractory unilateral temporo-parieto-occipital epilepsy to limit the propagation of epileptic discharges. As incomplete disconnection can lead to the residual seizures, detailed procedures are presented using cadaveric brain, three-dimensional (3D) reconstruction and simulation models, and intraoperative photographs. METHODS: A formalin-fixed adult cadaveric brain was dissected to show each step in PQD...
August 30, 2018: World Neurosurgery
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