The majority of patients with epilepsy maintain seizure control during pregnancy. The apparently higher risk of seizures among women treated with oxcarbazepine and the more frequent increases in drug load in the oxcarbazepine and lamotrigine cohorts prompts further studies on relationships with pharmacokinetic changes. Risks associated with status epilepticus appear to be lower than previously reported.

Objective It has been suggested that multilobar epilepsies caused by lesions restricted to the posterior cerebral quadrant (ie, the parietal, temporal, and occipital lobes) can be treated successfully by a procedure termed posterior disconnection. The objective of the present paper was to identify determinants of the epileptological outcome following posterior disconnection surgery. Methods The authors retrospectively analyzed a series of 29 consecutive patients undergoing posterior disconnection surgery between 2005 and 2017 for the treatment of refractory posterior quadrantic epilepsy. Specifically, all presurgical and postoperative magnetic resonance (MR) studies were reviewed to identify cases with an incomplete disconnection, or the presence of a more widespread pathology involving the whole hemisphere rather than only its posterior quadrant. In addition, we reevaluated all presurgical video–electroencephalography (EEG) reports. Results Seizure‐free (International League Against Epilepsy [ILAE] 1) after surgery were 3/3 patients with EEG findings restricted to the posterior quadrant, 0/7 patients who had propagation of epileptic activity to the contralateral frontal lobe, and 11/19 (57.9%) who showed propagation to ipsilateral frontal and/or contralateral posterior. Eleven of 13 (84.6%) patients with purely posterior quadrantic magnetic resonance imaging (MRI) findings (as retrospectively diagnosed by neuroimaging) vs 3/16 (18.8%) cases with additional subtle abnormalities outside the posterior quadrant became seizure‐free (P = .001). Eleven of 16 (68.8%) patients with complete disconnections were seizure‐free vs only 3/13 (23.0%) cases with leftover temporal lobe tissue with contact to the insula (P = .025, both Fisher's exact test). Significance A posterior disconnection is a technically demanding but very effective operation for posterior quadrantic epilepsy. Good epileptologic outcomes require not only that the epileptogenic lesion does not extend beyond the confines of the disconnected cerebral volume but also the absence of subtle MRI abnormalities, more widespread than the clear‐cut lesion of the posterior quadrant. Hemispheric or contralateral (particularly frontal) propagation of the epileptic activity may also indicate the presence of a hemispheric rather than posterior quadrantic pathology.

deficiency causes severe early-onset disease affecting the central and peripheral nervous systems. Microcephaly is probably not a universal feature.

Neuroimaging examines the relationship between abnormalities of brain function in epilepsy patients (seizures, impaired cognitive function, psychiatric co-morbidity etc.) and focal or more widespread brain pathology. Since the mid-1980s, the introduction of magnetic resonance imaging (MRI) into clinical neurology has had an impact on the diagnosis, treatment, and research of epilepsy only comparable with the advent of the electroencephalography (EEG) fifty years ago. MRI plays the important role of identifying single or multiple structural lesions responsible for the epileptic seizures. Thus, visual assessment of MRI plays an important role in the differentiation between symptomatic, cryptogenic, and idiopathic epilepsies. This diagnostic step leads to therapeutic decisions (medical treatment vs. surgery) and prognostic evaluations. If a structural lesion identified with MRI correlates with seizure-type, EEG and other clinical data, the likelihood of rendering the patient seizure free with epilepsy surgery is increased. Clinical research into epilepsy uses quantitative MRI (volumetry, T2-relaxometry, magnetic resonance spectroscopy [MRS], voxel-based morphometry) to reduce those cases initially labeled as cryptogenic. Quantitative MRI questions the belief that there is epilepsy without structural brain abnormality at all. Functional MRI (fMRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT) demonstrate changes associated with epileptic seizures and pathology, and changes associated with EEG abnormalities and their cessation. Functional neuroimaging is also used for the identification of functional brain tissue before surgery. Physiologically or pathologically active neuronal tissue is believed to be identified by glucose or oxygen consumption (PET), cerebral blood flow (PET, SPECT, perfusion MRI), and cerebral blood oxygenation (blood oxygenation level dependent [BOLD] fMRI). PET also offers the opportunity to visualize the in-vivo distribution of neuronal receptors which are implicated in the generation, the spread, and the cessation of seizures.

Clinical and EEG findings in eleven patients with insular epilepsiesn Abstract Purpose To study auras, seizure semiology, and EEG findings in insular epilepsies.

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