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1.
Shaheryar F. Ansari Cormac O. Maher R. Shane Tubbs Colin L. Terry Aaron A. Cohen-Gadol 《Child's nervous system》2010,26(7):945-951
Purpose
Previous small studies have demonstrated that seizure outcomes following surgery for extratemporal lobe epilepsy (ETLE) in children are worse than those for temporal lobe epilepsy. We have conducted a meta-analysis of the available literature to better understand ETLE surgical outcomes in children.Methods
We searched PubMed (1990–2009) for appropriate studies using the following terms: ETLE, ETLE surgery, ETLE surgery outcome, frontal lobe epilepsy, occipital lobe epilepsy, and parietal lobe epilepsy. Our collected data included patient age at seizure onset and surgery, the cerebral lobe involved with epileptogenesis, MRI findings, predominant seizure semiology, intracranial monitoring use (electrode implantation), epileptic region histopathology, and postoperative seizure outcome. Statistical analysis was performed to determine associations among these variables and postoperative outcome.Results
Ninety-five patients from 17 studies satisfied the inclusion criteria. Pathological findings (p?=?0.039) and seizure type (p?=?0.025) were significantly associated with outcome: A larger proportion of patients with cortical dysplasia and complex partial seizures experienced better outcomes. Age at surgery (p?=?0.073) and the cerebral resection site (p?=?0.059) were marginally associated with seizure outcome.Conclusions
This study confirms previous reports: Surgical outcomes for ETLE epilepsy are significantly worse than those for temporal lobe epilepsy. The reasons for this difference may include the diffuse nature of the pathology involved in ETLE, difficulty in localizing the seizure focus in young children, and involvement of “eloquent” nonresectable cortex in epileptogenesis. Because of the reporting variability among different epilepsy centers, more uniform protocols are necessary for fair evaluation and comparison of outcomes among the different centers. 相似文献2.
Dario J. Englot Martin J. Rutkowski Michael E. Ivan Peter P. Sun Rachel A. Kuperman Edward F. Chang Nalin Gupta Joseph E. Sullivan Kurtis I. Auguste 《Child's nervous system》2013,29(10):1915-1922
Purpose
Most children with medically refractory temporal lobe epilepsy (TLE) become seizure free after temporal lobectomy, but some individuals continue to seize. As studies of temporal lobectomy typically focus on seizure freedom, the effect of surgery on seizure type and frequency among children with persistent seizures is poorly understood. Seizures which impair consciousness are associated with increased morbidity compared to consciousness-sparing seizures.Methods
A retrospective cohort study was performed to evaluate the effects of temporal lobectomy on seizure type and frequency in children with intractable TLE.Results
Among 58 pediatric TLE patients with a mean (±SEM) age of 14.0?±?0.7 years who received temporal lobectomy, 46 (79.3 %) individuals achieved an Engel class I seizure outcome, including 38 (65.5 %) children who became completely seizure free (Engel IA). Mean follow-up was 2.7?±?0.4 years. While the number of patients experiencing simple partial seizures (SPSs) (consciousness sparing) decreased by only 23 % after surgery, the number of children having complex partial seizures and generalized tonic–clonic seizures (consciousness impairing) diminished by 87 and 83 %, respectively (p?<?0.01). SPS was the predominant seizure type in only 11.3 % of patients before resection, but in 42.1 % of patients with postoperative seizures (p?<?0.01). Children with postoperative seizures experienced a 70 % reduction in overall seizure frequency compared to baseline (p?<?0.05), having consciousness-impairing seizures 94 % less frequently (p?<?0.05), but having consciousness-sparing seizures 35 % more frequently (p?=?0.73).Conclusions
Seizure type and frequency are important considerations in the medical and surgical treatment of children with epilepsy, although complete seizure freedom remains the ultimate goal. 相似文献3.
Caitlin E. Hoffman Ayako Ochi Orlando Carter SneadIII Elysa Widjaja Cynthia Hawkins Martin Tisdal James T. Rutka 《Child's nervous system》2016,32(4):629-640
Purpose
Rasmussen’s encephalitis (RE) is a hemispheric inflammatory disorder resulting in progressive epilepsy, hemiparesis, and cognitive decline. Controversy surrounds the most effective timing of surgery with respect to language dominance, functional status, and seizure outcome. We describe our experience with RE to inform treatment decisions.Methods
A retrospective chart review was performed in children diagnosed with RE from 1983 to 2012.Results
Thirteen consecutive cases were identified: six males and seven females with a mean age of 10.6 years (range 5–18). Nine patients received immunotherapy, with transient benefit in three, treatment-associated complications in two, and no difference in their mean time to treatment (5.38 vs 6.37 years p?=?0.74) or long-term outcome. Mean follow-up was 5.6 years (range 0.58–12.25). There was no difference in outcome based on pre-operative duration of seizures. At last follow-up, 63 % of surgically treated patients achieved seizure freedom, 100 % had improved seizure control, 90 % had improved cognitive function, 36 % stopped medication, and 63 % tapered medication. Language improved in 83 % of patients with dominant disease. These findings were not associated with age at treatment. All surgical patients were ambulatory at last follow-up.Conclusions
Hemispherotomy achieves good seizure control with cognitive improvement and ambulatory status post-operatively. Time to surgery and dominant disease were not associated with outcome, suggesting that hemispherotomy can be offered early or late, with expectations of good seizure control and functional outcome, even with dominant disease.4.
Francisco Villarejo-Ortega Marta García-Fernández Concepción Fournier-Del Castillo Martín Fabregate-Fuente Juan Álvarez-Linera Inmaculada De Prada-Vicente Marcelo Budke María-Luz Ruiz-Falcó María-Ángeles Pérez-Jiménez 《Child's nervous system》2013,29(3):475-488
Purpose
The aim of this study is to describe a series of pediatric hemispherectomies, reviewing pathologic substrate, epilepsy characteristics and seizure outcome as well as developmental profiles, before and after surgery, in different domains.Methods
Seventeen patients with full pre-surgical work-up, minimum follow-up of 12 months, and at least one post-surgical neuropsychological evaluation were selected. Three had Rasmussen encephalitis (RE), five hemispheric malformations of cortical development (MCD), and nine hemispheric vascular lesions.Results
At latest follow-up, all patients with RE and 66.7 % of those with vascular lesions are in Engel’s class I; in the latter group, pre-surgical independent contralateral EEG discharges statistically correlated with a worse seizure outcome. Patients with MCD showed the worst seizure outcome. Pre-surgical language transfer to the right hemisphere was confirmed in a boy with left RE, operated on at 6 years of age. Patients with MCD and vascular lesions already showed severe global developmental delay before surgery, which persists afterwards. A linear correlation was found between earlier age at surgery and better outcome in personal–social, gross motor, and adaptive domains, in the vascular lesions group. The case with highest cognitive improvement had continuous spike and wave during sleep on pre-surgical EEG.Conclusions
Pathologic substrate was the main factor related with seizure outcome. In children with MCD and vascular lesions, although developmental progression is apparent, significant post-surgical improvements are restricted by the severity of pre-surgical neuropsychological disturbances and a slow maturation. Early surgery assessment is recommended to enhance the possibilities for a better quality of life in terms of seizure control, as well as better autonomy and socialization. 相似文献5.
Lorenzo Caciagli Corey Ratcliffe Fenglai Xiao Louis A. van Graan Karin Trimmel Christian Vollmar Maria Centeno John S. Duncan Pamela J. Thompson Sallie Baxendale Matthias J. Koepp Britta Wandschneider 《Epilepsia》2023,64(10):2792-2805
Objective
The cognitive profile of juvenile absence epilepsy (JAE) remains largely uncharacterized. This study aimed to: (1) elucidate the neuropsychological profile of JAE; (2) identify familial cognitive traits by investigating unaffected JAE siblings; (3) establish the clinical meaningfulness of JAE-associated cognitive traits; (4) determine whether cognitive traits across the idiopathic generalized epilepsy (IGE) spectrum are shared or syndrome-specific, by comparing JAE to juvenile myoclonic epilepsy (JME); and (5) identify relationships between cognitive abilities and clinical characteristics.Methods
We investigated 123 participants—23 patients with JAE, 16 unaffected siblings of JAE patients, 45 healthy controls, and 39 patients with JME—who underwent a comprehensive neuropsychological test battery including measures within four cognitive domains: attention/psychomotor speed, language, memory, and executive function. We correlated clinical measures with cognitive performance data to decode effects of age at onset and duration of epilepsy.Results
Cognitive performance in individuals with JAE was reduced compared to controls across attention/psychomotor speed, language, and executive function domains; those with ongoing seizures additionally showed lower memory scores. Patients with JAE and their unaffected siblings had similar language impairment compared to controls. Individuals with JME had worse response inhibition than those with JAE. Across all patients, those with older age at onset had better attention/psychomotor speed performance.Significance
JAE is associated with wide-ranging cognitive difficulties that encompass domains reliant on frontal lobe processing, including language, attention, and executive function. JAE siblings share impairment with patients on linguistic measures, indicative of a familial trait. Executive function subdomains may be differentially affected across the IGE spectrum. Cognitive abilities are detrimentally modulated by an early age at seizure onset. 相似文献6.
Prof. Dr. H. Stefan 《Zeitschrift für Epileptologie》2014,27(1):26-30
Background
Approximately 20-40?% of epilepsy patients show drug resistance and a large number of patients under antiepileptic therapy suffer from side effects including cognitive disorders and depression. Transcutaneous vagus nerve stimulation (t-VNS) can be used for these patients as a supplementary treatment to resection epilepsy surgery.Aim
The main aims of this investigation were to test the safety, tolerability and practicality of t-VNS in epilepsy patients.Material and methods
For the proof of concept trial ten patients with pharmacoresistant epilepsy (eight with focal and two with generalized epilepsy) were recruited. For admission to the study a minimum frequency of four seizures per month was necessary. The medication dosage was kept constant in the baseline and in the total treatment phase. The auricular branch of the vagus nerve (ABVN) of the left ear was stimulated. The stimulation pulses were biphasic with a frequency of 10/s and a pulse width of 300 µs. After an initial training period the stimulation was carried out in the morning, midday and evening for 1 h each over a period of 9 months. The subjectively experienced frequency of seizures, continuous video EEG (electroencephalogram) long-term conduction carried out 4 times for 1 week each and cognitive and functional alterations were considered to be end point parameters.Results
The total treatment period of 9 months was completed by seven patients. Of these seven patients five showed a reduction in the frequency of seizures during the 9-month treatment period and two reported an increase in seizures. In two patients the seizure frequency was reduced by 45 % and 48 % in a comparison between baseline and end of treatment. In two further patients contradictions arose between the subjective report on seizure frequency and the objectively quantified frequency in the video EEG. For one patient the interictal epileptic EEG activity was continually reduced during the course of the 9-month period.Conclusion
The t-VNS procedure represents a procedure which is well tolerated and practical for long-term treatment. 相似文献7.
Javier Peña-Ceballos Patrick B. Moloney Tudor Munteanu Michael Doyle Niamh Colleran Brenda Liggan Annette Breen Sinead Murphy Hany El-Naggar Peter Widdess-Walsh Norman Delanty 《Epilepsia》2023,64(5):1225-1235
Objective
Recent clinical trials have shown that cenobamate substantially improves seizure control in focal-onset drug-resistant epilepsy (DRE). However, little is known about cenobamate's performance in highly active ( ≥ 20 seizures/month) and ultra-refractory focal epilepsy ( ≥ 6 failed epilepsy treatments, including antiseizure medications [ASMs], epilepsy surgery, and vagus nerve stimulation). Here, we studied cenobamate's efficacy and tolerability in a “real-world” severe DRE cohort.Methods
We conducted a single-center retrospective analysis of consecutive adults treated with cenobamate between October 2020 and September 2022. All patients received cenobamate through an Early Access Program. Cenobamate retention, seizure outcomes, treatment-emergent adverse events, and adjustments to concomitant ASMs were analyzed.Results
Fifty-seven patients received cenobamate for at least 3 months (median duration, 11 months). The median cenobamate dose was 250 mg/day (range 75–350 mg). Baseline demographics were consistent with highly active (median seizure frequency, 60/month) and ultra-refractory epilepsy (median previously failed ASMs, nine). Most (87.8%) had prior epilepsy surgery and/or vagus nerve stimulation. Six patients stopped cenobamate due to lack of efficacy and/or adverse events. One patient died from factors unrelated to cenobamate. Among patients who continued cenobamate, three achieved seizure freedom (5.3% of cohort), 24 had a 75%–99% reduction in seizures (42.1% of cohort), and 16 had a 50%–74% reduction (28.1% of cohort). Cenobamate led to abolition of focal to bilateral tonic–clonic seizures in 55.6% (20/36) of patients. Among treatment responders, 67.4% (29/43) were treated with cenobamate doses of ≥ 250 mg/day. Three-fourths of patients reported at least one side-effect, most commonly fatigue and somnolence. Adverse events most commonly emerged at cenobamate doses of ≥ 250 mg/day. Side-effects were partially manageable by reducing the overall ASM burden, most often clobazam, eslicarbazepine, and perampanel.Significance
Patients with highly active and ultra-refractory focal epilepsy experienced meaningful seizure outcomes on cenobamate. Emergence of adverse events at doses above 250 mg/day may limit the potential for further improvements in seizure control at higher cenobamate doses. 相似文献8.
Purpose
To determine the clinical characteristics, surgical strategy, and outcome in pediatric lesional epilepsy patients younger than 5 years of age undergoing surgery in a single institute.Method
Retrospective data were collected and analyzed on patients younger than 5 years of age who underwent lesionectomy for lesional epilepsy at single institute from January 2001 to August 2010. Fourteen pediatric lesional epilepsy patients were enrolled in this study. Engel classification was used to classify seizure outcome.Results
Median preoperative seizure period was 1 month (range, 1–21). Median post-operative follow up period was 35 months (range 13–84). Ten patients who underwent gross total resection of tumor showed Engel class Ia seizure outcome without any antiepileptic drug (AED). Subtotal resection was performed in four patients to avoid eloquent area injury. Two of these four patients with subtotal removal became seizure-free (Engel class Ia) without AED, while two were in Engel class Ib with AED medication. There was no significant surgical morbidity or mortality.Conclusion
Lesionectomy in children younger than 5 years of age is relatively safe and effective in controlling seizures. Short preoperative seizure periods and total removal of tumor might be associated with good outcome. Therefore, early and complete lesionectomy alone may help allow for seizure freedom and optimal brain development in pediatric patients. 相似文献9.
Ekaterina Ivanova Viteva 《Annals of Indian Academy of Neurology》2014,17(1):35-42
Introduction:
The data in the scientific literature about the significance of seizure severity and frequency for the quality of life (QOL) of patients with refractory epilepsy (RE) are contradictory.Objective:
Our objective was to assess the impact of the seizure severity and frequency on the QOL of Bulgarian patients with RE.Materials and Methods:
A total of 70 patients with RE were studied by examining the medical documentation and seizure diaries. All study participants completed quality of life epilepsy inventory (QOLIE-89). Seizure severity of only 59 patients who had a seizure in the last month was assessed by the Liverpool seizure severity scale.Results:
A limited negative impact of the seizure severity and frequency on some aspects of the physical health, epilepsy, all aspects of the social health and epilepsy and the overall QOL has been demonstrated. A weak to moderate reverse correlation between the specified factors and the respective QOLIE-89 subscales has been found.Conclusion:
The clinical factors seizure severity and seizure frequency have a limited negative impact mostly on the social aspects of QOL. The study results support the multidisciplinary approach to persons with epilepsy. 相似文献10.
Purpose
Aicardi syndrome (AS) is a severe neurodevelopmental disorder characterized by the triad of seizures, agenesis of corpus callosum, and chorioretinal lacunae. Seizures in AS are typically frequent, of various types, and refractory to medical therapy. Optimal treatment of seizures in AS remains undetermined.Methods
We report a series of four patients with Aicardi syndrome who underwent surgical management of their epilepsy including two with corpus callosotomy (CC) of a partial corpus callosum and three with vagus nerve stimulator implantation.Results
Seizure outcome was variable and ranged from near complete resolution of seizures to worsening of seizure profile. The most favorable seizure outcome was seen in a patient with partial agenesis of the corpus callosum treated with CC.Conclusions
Seizure outcome following CC or vagus nerve stimulation in patients with Aicardi syndrome is variable. Although palliative epilepsy surgery may result in improvement in the seizure profile in some patients, studies on larger patient cohorts are needed to identify the precise role that surgery may play in the multidisciplinary approach to controlling seizures in Aicardi syndrome. 相似文献11.
Betweenness centrality of intracranial electroencephalography networks and surgical epilepsy outcome
Bartosz T. Grobelny Dennis London Travis C. Hill Emily North Patricia Dugan Werner K. Doyle 《Clinical neurophysiology》2018,129(9):1804-1812
Objective
We sought to determine whether the presence or surgical removal of certain nodes in a connectivity network constructed from intracranial electroencephalography recordings determines postoperative seizure freedom in surgical epilepsy patients.Methods
We analyzed connectivity networks constructed from peri-ictal intracranial electroencephalography of surgical epilepsy patients before a tailored resection. Thirty-six patients and 123 seizures were analyzed. Their Engel class postsurgical seizure outcome was determined at least one year after surgery. Betweenness centrality, a measure of a node’s importance as a hub in the network, was used to compare nodes.Results
The presence of larger quantities of high-betweenness nodes in interictal and postictal networks was associated with failure to achieve seizure freedom from the surgery (p?<?0.001), as was resection of high-betweenness nodes in three successive frequency groups in mid-seizure networks (p?<?0.001).Conclusions
Betweenness centrality is a biomarker for postsurgical seizure outcomes. The presence of high-betweenness nodes in interictal and postictal networks can predict patient outcome independent of resection. Additionally, since their resection is associated with worse seizure outcomes, the mid-seizure network high-betweenness centrality nodes may represent hubs in self-regulatory networks that inhibit or help terminate seizures.Significance
This is the first study to identify network nodes that are possibly protective in epilepsy. 相似文献12.
Background
Hemiconvulsion-hemiplegia-epilepsy (HHE) involves infantile-onset acute hemiconvulsive febrile status epilepticus with subsequent unilateral cerebral atrophy and hemiparesis. Chronic epilepsy later develops, typically involving refractory focal seizures; however, the underlying pathophysiology of this epilepsy is not well understood.Patient
We present a boy who had a typical acute presentation of HHE at 23?months, but an unusual evolution to chronic epilepsy in which the initially unaffected hemisphere was significantly abnormal. His initial acute presentation was right-sided hemiconvulsive febrile status epilepticus, with subsequent left cerebral hemiatrophy and hemiparesis affecting the right face, arm and leg. Focal seizures began at 5?years and were refractory to medical treatment. At 9?years, video EEG monitoring showed a striking pattern of interictal slow spike-wave and paroxysmal fast activity, maximal over the right, initially unaffected, hemisphere. He had primarily focal tonic seizures involving left-sided stiffening, also appearing to originate from the right hemisphere. Following left functional hemispherotomy he became seizure-free and parents reported improved cognitive function, attention and quality of life.Discussion
This boy had classic features of Lennox-Gastaut syndrome, but expressed almost exclusively over the right hemisphere, which was initially unaffected in his acute presentation of HHE. His evolution to “hemi-Lennox-Gastaut-like phenotype” illustrates the importance of monitoring chronic epilepsy in patients with HHE; early surgical intervention might prevent pathologic recruitment of bilateral secondary networks leading to the refractory seizures and cognitive impairment associated with Lennox-Gastaut syndrome. 相似文献13.
Sita Jayalakshmi Manas Panigrahi Rajesh Reddy Shanmukhi Somayajula 《Annals of Indian Academy of Neurology》2014,17(1):43-47
Context:
Hypothalamic hamartomas (HH) are ectopic masses of neuronal and glial tissue most commonly presenting with medically refractory gelastic seizures with evolution to other seizure types. They are also associated with cognitive and behavioral problems to varying extent. Surgery has been found to improve quality of life in more than 50% of patients.Aim:
To evaluate the clinical characteristics and long-term outcome of surgery in children with HH and refractory epilepsy.Materials and Methods:
A retrospective analysis of presurgical, surgical, and postsurgical data of six children who underwent surgery for HH and had at least 3 years follow-up was performed.Results:
Six children (male: female = 5:1) aged 3-16 years (at the time of surgery) underwent surgical resection of HH for refractory epilepsy. At last follow-up (range 3-9 years), three children were in Engel''s class I, two in Class II, and one in class III outcome. Significant improvement in behavior, quality of life was noted in four children; while the change in intelligence quotient (IQ) was marginal.Conclusions:
Medically refractory epilepsy associated with behavioral and cognitive dysfunction is the most common presentation of HH. Open surgical resection is safe with favorable outcome of epilepsy in 50% with significant improvement in behavior and marginal change in cognitive functions. 相似文献14.
Anupam Jaiswal Ravindra Kumar Garg Hardeep Singh Malhotra Rajesh Verma Maneesh Kumar Singh 《Annals of Indian Academy of Neurology》2015,18(1):39-44
Purpose:
Cerebral hemiatrophy is a common childhood disease. It clinically manifests with seizures, hemiparesis and mental retardation.Materials and Methods:
In this prospective study, previously untreated patients with seizures and cerebral hemiatrophy were recruited. Cerebral hemiatrophy was diagnosed on the basis of hemispheric ratio. Patients with acquired hemiconvulsion, hemiplegia, and epilepsy (HHE) syndrome were included in group A. Group B included patients with congenital HHE syndrome. Patients were followed up for 6 months for seizure recurrence.Results:
Out of 42 patients 26 were in group A and 16 were in group B. After 6 months, there was significant reduction in seizure frequency (P < 0.0001) in both the groups. At least 50% reduction in seizure frequency was noted in all the patients. Complete seizure freedom was observed in 15 (35.7%) patients. Seizure recurrences were significantly higher (P = 0.008) in group A. On univariate analysis, predictors of seizure recurrences were history of febrile seizures (P = 0.013), hippocampal sclerosis (P = 0.001), thalamic atrophy (P = 0.001), basal ganglia atrophy (P = 0.001), cerebellar atrophy (P = 0.01), ventricular dilatation (P = 0.001), epileptiform discharges at presentation (P = 0.023), complex partial seizures (P = 0.006) and status epilepticus (P = 0.02). On multivariate analysis, hemispheric ratio was the only significant factor for seizure recurrence.Conclusion:
Patients with congenital hemiatrophy had better seizure control than that in patients with HHE syndrome. 相似文献15.
Shimrit Uliel-Sibony Uri Kramer Itzhak Fried Aviva Fattal-Valevski Shlomi Constantini 《Child's nervous system》2011,27(9):1413-1418
Purpose
This paper summarizes our experience with surgical treatment of pediatric low-grade glial temporal lobe tumors focusing on the long-term outcome of seizures and identifying factors associated with seizure control and failure.Methods
We reviewed all medical records of pediatric patients that underwent temporal lobe surgery due to seizures at our institution between 1997 and 2009. Only patients with temporal lobe tumors were included in this series. The files were retrospectively reviewed for seizure history. All children had undergone pre- and postoperative evaluation, neurological examination, EEG, and MRI.Results
The cohort includes 48 children with mean follow-up time of 5.15?years (1?C12?years). The mean age at surgery was 8.2?years (1?C18.1) and the mean seizure duration until surgery was 2.6?years. All lesions in the cohort were low-grade tumors; pilocytic astrocytoma was the most common (41%). Eighty-three percent of the patients were classified as Engel class I following surgery. There was no correlation between Engel score and the preoperative epilepsy duration, age of seizure onset or type of seizures, and pathology. The surgical complication rate was 4.1% (2/48).Conclusions
Surgical treatment for seizure control in children and adolescents with low-grade temporal tumors provides excellent long-term results. 相似文献16.
Bledi Brahimaj Hansel M. Greiner James L. Leach Paul S. Horn Charles B. Stevenson Lili Miles Anna Byars Katherine Holland Mary Sutton Francesco T. Mangano 《Child's nervous system》2014,30(8):1383-1391
Objective
Children suffering from epilepsy with suspected low-grade tumors may benefit from a surgical approach that considers the epileptogenic zone, which can be more extensive than the tumor region. This study aimed to determine the prevalence of epilepsy in children undergoing supratentorial tumor resection and the factors predictive of postoperative seizure freedom in children with low-grade tumors.Methods
Subjects 3 months to 21 years undergoing supratentorial brain tumor resection between 2007 and 2011 were included in this retrospective study. Children with supratentorial, cortically based tumors and a preoperative diagnosis of epilepsy were considered epilepsy surgery candidates. Pre- and postoperative MRI were reviewed and scored for extent of resection, adjacent dysplasia, and remaining abnormal cortex postoperatively.Results
The prevalence of seizures in all cases of supratentorial tumors was 46/87 (53 %). Eighteen were epilepsy surgery candidates. Eight of 18 (44 %) were seizure-free postoperatively with a mean follow-up of 39 months. Children who were seizure free postoperatively had tried fewer anticonvulsants than those with continued seizures (1.7 v. 2.9, p?=?0.01). Presurgical evaluation was nonstandardized, and a more extensive workup and resection were performed in children who continued to have seizures postoperatively.Conclusions
All epilepsy surgery candidates had low-grade tumors on histological evaluation, indicating that a surgical approach that takes into consideration the epileptogenic zone is reasonable in this population. Gross total resection should be the goal, with additional attention to resection of the epileptogenic zone when located in the noneloquent cortex. 相似文献17.
Wallace DJ Byrne RW Ruban D Cochran EJ Roh D Whisler WW 《Clinical neurology and neurosurgery》2011,113(10):918-922
Objective
To review clinical features and surgical outcome in patients with temporal lobe pleomorphic xanthoastrocytomas (PXAs) and intractable epilepsy.Methods
The Rush Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of a temporal lobe PXA at Rush University Medical Center. Medical records were reviewed for demographic, procedure and follow-up data.Results
Four patients were identified with a temporal lobe PXA and intractable epilepsy. Average age of seizure onset was 16.5 years and delay to surgery was 90 months. Complex partial seizures were the most common presenting symptom, shown in all 4 patients, and 3 of 4 patients presented with simple partial seizures as well. Seizures occurred with an average frequency of 4 per month (range 1-12 per month). Detailed operative and post-operative follow up data was available for all 4 patients. Gross total resection of the tumor was achieved in all 4 cases. Three of 4 cases had complete resection of the amygdala, and 3 cases had resections of the hippocampus (one partial and two complete). On histopathology, all tumors were found to be low-grade, without mitoses or necrosis. Average follow-up was 120 months (range 29-296 months) with all 4 patients achieving Engel's class I outcome. At last follow up, there was no radiographic or clinical evidence of tumor recurrence. There were no permanent complications.Conclusions
Temporal lobe pleomorphic xanthoastrocytomas causing chronic intractable epilepsy occur in younger patients, and demonstrate excellent long-term results in seizure improvement and tumor control with surgery. We support the choice between simple lesionectomy and a tailored resection with amygdalohippocampectomy guided by preoperative findings, intraoperative electrocorticography, and the severity and chronicity of the patient's epilepsy. 相似文献18.
Amir Nazem Amir Hossein Jafarian Seyed Homayoon Sadraie Ali Gorji Hamed Kheradmand Mahla Radmard Hossein Haghir 《Child's nervous system》2012,28(11):1931-1936
Purpose
Although simple febrile seizures are frequently described as harmless, there is evidence which suggests that hippocampal damage may occur after simple febrile seizures. This study aimed to investigate possible neuronal damages as well as alterations in cytogenesis in the hippocampal dentate gyrus following simple febrile seizures.Methods
Simple febrile seizure was modeled by hyperthermia-induced seizures in 22-day-old male rats. The brains were removed 2 or 15?days after hyperthermia in all rats with (n?=?20) and without (n?=?10) occurrence of seizures as well as in control animals (n?=?10). The sections were stained with hematoxylin and eosin to estimate the surface numerical density of dark neurons. Ki-67 immunohistochemistry was performed to evaluate changes of cytogenesis following simple febrile seizures.Results
Hyperthermia induced behavioral seizure activities in 67?% of the rats. The numerical densities of dark neurons as well as the mean Ki-67 index (the fraction of Ki-67-positive cells) were significantly increased in dentate gyrus after induction of seizures by hyperthermia compared to both controls and rats without seizure after hyperthermia. Both the seizure duration and intensity were correlated significantly with numerical densities of dark neurons (but not with Ki-67 index).Conclusion
The data indicate that simple febrile seizures can cause neuronal damages and enhancement of cytogenesis in the hippocampal dentate gyrus, which were still visible for at least 2?weeks. These findings also suggest the correlation of febrile seizure intensity and duration with neuronal damage. 相似文献19.
Xinghui He Kai Zhang Dingyang Liu Zhuanyi Yang Xuejun Li Zhiquan Yang 《CNS Neuroscience & Therapeutics》2023,29(2):736-743
Aims
We aimed to identify predictors of postoperative seizures in patients with diffuse low-grade glioma (DLGG)-related epilepsy after complete tumor resection in this study.Methods
We retrospectively collected data from individuals with DLGG-related epilepsy whose tumors were completely resected at Xiangya Hospital, Central South University between January 2014 and January 2020. The predictors of seizure outcomes were assessed by employing univariate analysis and a multivariate logistic regression model in a backward binary logistic regression model.Results
Among the 118 cases that met the inclusion criteria, 83.05% were seizure-free following an average follow-up of 4.27 ± 1.65 years, all of whom were classified as International League Against Epilepsy class I outcome. Univariate and multivariate analyses indicated that seizure duration of >6 years (odds ratio [OR], 6.62; 95% confidence interval [CI], 1.76–24.98; p = 0.005) and first clinical symptoms other than seizures (OR, 4.51; 95% CI, 1.43–14.23; p = 1.010) were both independent predictors of unfavorable seizure outcomes.Conclusion
Our results imply that satisfactory seizure outcomes can be achieved in most patients with DLGG-related epilepsy after complete tumor resection. Patients with seizure duration of >6 years or first clinical symptoms other than seizures were more likely to experience postoperative seizure recurrence. 相似文献20.
Riёm El Tahry Z. Irene Wang Aung Thandar Irina Podkorytova Balu Krishnan Simon Tousseyn Wu Guiyun Richard C. Burgess Andreas V. Alexopoulos 《Clinical neurophysiology》2018,129(8):1651-1657