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Refractory epilepsy

Chinekwu Anyanwu, Gholam K Motamedi
Despite appropriate trials of at least two antiepileptic drugs, about a third of patients with epilepsy remain drug resistant (intractable; refractory). Epilepsy surgery offers a potential cure or significant improvement to those with focal onset drug-resistant seizures. Unfortunately, epilepsy surgery is still underutilized which might be in part because of the complexity of presurgical evaluation. This process includes classifying the seizure type, lateralizing and localizing the seizure onset focus (epileptogenic zone), confirming the safety of the prospective brain surgery in terms of potential neurocognitive deficits (language and memory functions), before devising a surgical plan...
March 21, 2018: Brain Sciences
Erin D'Agostino, Vyacheslav Makler, David F Bauer
BACKGROUND: Vagal nerve stimulation (VNS) is a safe and well-tolerated treatment for drug resistant epilepsy. Complications and failure of the device can result from lead fracture, device malfunction, disconnection, or battery displacement and can result in a variety of symptoms. We present an interesting case of stimulator malfunction with increased impedance change seen only with a change in head position. CASE DESCRIPTION: Patient is a 25-year-old male with a vagal nerve stimulator (VNs) placed for medically refractory epilepsy who presented with neck pain and an electrical pulling sensation in his neck whenever he turned his head to the right...
March 16, 2018: World Neurosurgery
Sarah F Pollack, Olivia R Grocott, Kimberly A Parkin, Anna M Larson, Ronald L Thibert
Angelman syndrome (AS) is a neurogenetic imprinting disorder caused by loss of the maternally inherited Ube3a gene and is characterized by generalized epilepsy, limited expressive speech, sleep dysfunction, and movement disorders. Myoclonic seizures are often the first seizure type to appear, and myoclonic status, associated with developmental regression, may occur in the first few years of life. Additionally, there have been rare reports of prolonged episodes of myoclonus without electrographic correlate in adults with AS...
March 16, 2018: Epilepsy & Behavior: E&B
Ludovica Pasca, Roberto H Caraballo, Valentina De Giorgis, J Gabriela Reyes, Joyce A Macasaet, Silvia Masnada, Marisa Armeno, Massimo Musicco, Anna Tagliabue, Pierangelo Veggiotti
PURPOSE: To evaluate the efficacy and tolerability of the ketogenic diet (KD) as a treatment for drug-resistant epilepsy secondary to malformations of cortical development. METHODS: A two-centre retrospective analysis of 45 paediatric patients with refractory epilepsy due to malformation of cortical development was carried out. Patients were divided into three groups based on malformation type: abnormal neural proliferation (Group 1); abnormal neural migration (Group 2) and abnormal post-migrational development (Group 3)...
March 8, 2018: Seizure: the Journal of the British Epilepsy Association
Louis Ross, Ahsan M Naduvil, Juan C Bulacio, Imad M Najm, Jorge A Gonzalez-Martinez
BACKGROUND: Laser ablation surgery has had encouraging results in the treatment of multiple intracranial diseases including primary and metastatic brain tumors, radiation necrosis, and epilepsy. The use of the stereoelectroencephalography (SEEG) method in combination with laser thermocoagulation therapy with the goal of modulating epileptic networks in patients with neocortical nonlesional phamacoresistant epilepsy has not been previously described. OBJECTIVE: To describe the novel methodological and conceptual aspects related to SEEG-guided laser ablations in patients with magnetic resonance imaging (MRI)-negative pharmacoresistant neocortical focal epilepsy...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Kai Lehtimäki, Volker A Coenen, Antonio Gonçalves Ferreira, Paul Boon, Christian Elger, Rod S Taylor, Philippe Ryvlin, Antonio Gil-Nagel, Frans Gielen, Thomas C Brionne, Abdallah Abouihia, Grégory Beth
BACKGROUND: The Medtronic Registry for Epilepsy (MORE; Medtronic Inc, Dublin, Ireland) is an open label observational study evaluating the long-term effectiveness, safety, and performance of deep brain stimulation (DBS) of the anterior nucleus of thalamus (ANT) for the treatment of refractory epilepsy. OBJECTIVE: To compare the difference in success rate of placing contacts at ANT-target region (ANT-TR) between transventricular (TV) and extraventricular (EV) lead trajectories in 73 ANT-DBS implants in 17 European centers participating in the MORE registry...
March 15, 2018: Neurosurgery
Dennis D Spencer, Jason L Gerrard, Hitten P Zaveri
Intracranial electrophysiological recording in patients with refractory focal epilepsy is the gold standard for defining epileptogenic tissue. Although the concordance of intracranial electrophysiology, structural MRI, and pathology can identify brain regions for resection, complete seizure control after surgery is not achieved in all patients with focal epilepsy. Repetitive identical behavioural seizures suggest one onset area, but epileptogenesis might be distributed and connected by functional and structural brain networks outside the seizure onset area, which could explain poor postsurgical outcomes in some patients...
April 2018: Lancet Neurology
Chang-Ching Wei, Ji-Nan Sheu, Jung-Tung Liu, Sheng-Hui Yang, I-Ching Chou, Jeng-Dau Tsai
BACKGROUND: Seizures in tuberous sclerosis complex (TSC) tend to be intractable over time and become a subsequent psychological burden for the patients. The purpose of the current study was to describe the onset, phenotype, and factors associated with seizure remission in patients with TSC. METHODS: Patients diagnosed with TSC between 2009 and 2015 completed a questionnaire interview and underwent a systematic evaluation, including a medical review of their epilepsy history and neurobehavioral disorder assessment...
March 15, 2018: Journal of the Chinese Medical Association: JCMA
Rumiko Takayama, Katsumi Imai, Hiroko Ikeda, Koichi Baba, Naotaka Usui, Yukitoshi Takahashi, Yushi Inoue
We describe two cases of refractory epilepsy with cerebral hemiatrophy and contralateral electroencephalographic (EEG) abnormalities, in which hemispherotomy of the atrophic hemisphere effectively controlled seizures. Case 1 was a 5-year-1-month-old girl with refractory bilateral asymmetrical tonic posturing seizures predominantly in the right arm. Magnetic resonance imaging showed left porencephaly corresponding to a left middle cerebral artery infarction. Case 2 was a 3-year-8-month-old boy with refractory bilateral asymmetrical tonic posturing seizures predominantly in the right arm due to atrophy of the left cerebral hemisphere after septic meningitis...
March 14, 2018: Brain & Development
Emily C Mahoney, Andrew Zeng, Wilson Yu, Mackenzie Rowe, Siddhartha Sahai, Paul J Feustel, Adolfo Ramirez-Zamora, Julie G Pilitsis, Damian S Shin
Approximately 30% of individuals with epilepsy are refractory to antiepileptic drugs and currently approved neuromodulatory approaches fall short of providing seizure freedom for many individuals with limited utility for generalized seizures. Here, we expand on previous findings and investigate whether ventral pallidum deep brain stimulation (VP-DBS) can be efficacious for various acute seizure phenotypes. For rats administered pilocarpine, we found that VP-DBS (50 Hz) decreased generalized stage 4/5 seizure median frequency from 9 to 6 and total duration from 1667 to 264 s even after generalized seizures emerged...
March 9, 2018: Epilepsy Research
Iris Gorny, Kristina Krause, Anita Albert, Sabrina Schneider, Leona Möller, Lena Habermehl, Adam Strzelczyk, Felix Rosenow, Anke Hermsen, Susanne Knake, Katja Menzler
Objectives: The German socio-demographic estimation scale was developed by Jahn et al. (1) to quickly predict premorbid global cognitive functioning in patients. So far, it has been validated in healthy adults and has shown a good correlation with the full and verbal IQ of the Wechsler Adult Intelligence Scale (WAIS) in this group. However, there are no data regarding its use as a bedside test in epilepsy patients. Methods: Forty native German speaking adult patients with refractory epilepsy were included...
2018: Frontiers in Neurology
M Armeno, C Araujo, B Sotomontesano, R H Caraballo
INTRODUCTION: The ketogenic diet is a non-pharmacological treatment that has been used as a therapeutic alternative for the management of refractory epilepsy since 1921. It is a diet, high in fats and low in carbohydrates, which is used to treat paediatric refractory epilepsy, and is effective in around 50% of the patients that begin to follow it. It is a nutrition plan that is imbalanced in terms of both macro- and micro-nutrients, which can give rise to nutritional deficits in energy, proteins, minerals and vitamins, as well as an excess of lipids...
March 16, 2018: Revista de Neurologia
V N Vakharia, J S Duncan, J-A Witt, C E Elger, R Staba, J Engel
Neurosurgery is an under-utilised treatment that can potentially cure drug-refractory epilepsy. Careful, multidisciplinary pre-surgical evaluation is vital for selecting patients and ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guide surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures, and associated outcome data...
March 13, 2018: Annals of Neurology
J M Mercadé Cerdá, F J López Gonzalez, P Serrano Castro, M D Castro Vilanova, D M Campos Blanco, M R Querol Pascual
INTRODUCTION: The study aims to quantify the types of antiepileptic drugs (AED) prescribed in neurology consultations. MATERIAL AND METHOD: This descriptive, observational study included a sample of 559 patients older than 14 years, diagnosed with epilepsy, and receiving pharmacological treatment. Data were collected at outpatient consultations by 47 Spanish neurologists in May 2016. Epilepsy was defined based on the International League Against Epilepsy classification...
March 9, 2018: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Christopher S Parker, Jonathan D Clayden, M Jorge Cardoso, Roman Rodionov, John S Duncan, Catherine Scott, Beate Diehl, Sebastien Ourselin
Patients with medically-refractory focal epilepsy may be candidates for neurosurgery and some may require placement of intracranial EEG electrodes to localise seizure onset. Assessing cerebral responses to single pulse electrical stimulation (SPES) may give diagnostically useful data. SPES produces cortico-cortical evoked potentials (CCEPs), which infer effective brain connectivity. Diffusion-weighted images and tractography may be used to estimate structural brain connectivity. This combination provides the opportunity to observe seizure onset and its propagation throughout the brain, spreading contiguously along the cortex explored with electrodes, or non-contiguously...
2018: NeuroImage: Clinical
David Neubauer, Mirjana Perković Benedik, Damjan Osredkar
PURPOSE: Refractory epilepsies in children present a major burden for patients and their families. Cannabidiol (CBD) has been suggested as a potential treatment for refractory epilepsies. The aim of this study was to evaluate the effectiveness of add-on therapy with CBD for the treatment of refractory childhood epilepsies. METHOD: Patients with childhood-onset refractory epilepsy, treated at the tertiary epilepsy center of the University Children's Hospital Ljubljana, Slovenia, were included in the study...
March 8, 2018: Epilepsy & Behavior: E&B
O Fernández-Concepción, M López Jiménez, C Valencia-Calderón, A Calderón-Valdivieso, A Recasén-Linares, L Reyes-Haro, C Vásquez-Ham
INTRODUCTION: There is sufficient evidence on the usefulness of surgery as a therapeutic alternative for patients with drug-resistant epilepsy; however this treatment is underutilized, especially in developing countries. METHODS: We describe the outcomes of epilepsy surgery in 27 paediatric patients at Hospital Baca Ortiz in Quito, Ecuador. Our analysis considered the following variables: reduction in seizure frequency, surgery outcome according to the Engel classification, improvement in quality of life, and serious complications due to surgery...
March 7, 2018: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Naila Ismayilova, Mary-Anne Leung, Ravi Kumar, Martin Smith, Ruth E Williams
PURPOSE: The Ketogenic Diet (KD) is a well-established treatment for epilepsy in children and adults. We describe our 10-year KD experience in children less than two years of age diagnosed with medically refractory epilepsy. METHODS: We conducted a retrospective case-note review of infants managed with KD at our centre between 2006 and 2016. RESULTS: Twenty-nine children between 2½ weeks and 23 months of age were identified, with mixed epilepsy aetiologies...
March 2, 2018: Seizure: the Journal of the British Epilepsy Association
Karl Roessler, Burkhard S Kasper, Roland Coras, Soheil Arinrad, Michael Scholz, Hajo H Hamer, Ingmar Blümcke, Michael Buchfelder
BACKGROUND: Temporal lobe resection (TLR) including amygdalo-hippocampectomy (AHE) is the most frequent performed procedure in epilepsy surgery. Due to close anatomical relationship of the mesial temporal structures and the midbrain and choroidal fissure, the risk of severe complications like postoperative stroke is up to 2.5%. METHODS: We developed a modification of the classical technique for AHE by early entering the choroidal fissure for identification of crus cerebri, posterior cerebri artery and oculomotor nerve via the anterior part of the fronto- mesial temporal horn cleft...
March 7, 2018: World Neurosurgery
Vicenta Salanova
There are few reports of patients with parietal lobe epilepsy. One of the largest series, from the Montreal Neurological Institute (MNI), reported that patients with epileptogenic areas in the parietal cortex behind the postcentral gyrus comprised 6% of patients with refractory focal epilepsy treated surgically at the MNI between 1929 and 1988. Since then several other institutions have reported their experience with the evaluation and treatment of patients with parietal lobe epilepsy. This chapter reviews the functional anatomy of the parietal lobe, electroclinical manifestations and surgical outcome of parietal lobe epilepsy, and recent advances in the evaluation of patients with refractory focal epilepsy...
2018: Handbook of Clinical Neurology
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