Seizure's outcome after cortical resections including the face and tongue rolandic areas in patients with refractory epilepsy and normal MRI submitted to subdural grids' implantation

Cukiert, Arthur; Buratini, José Augusto; Machado, Elcio; Sousa, Alcione; Vieira, Joaquim; Forster, Cássio; Argentoni, Meire; Baldauf, Cristine; Frayman, Leila

doi:10.1590/s0004-282x2001000500012

Cited by 19 publications

(11 citation statements)

References 11 publications

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“…This observation has also been noted by Lehman et al 25 and Cukiert et al 9 in their series of patients surgically treated for epilepsy arising from the sensorimotor face area. Whether this transient dysphasia is related to interruption of contiguous language networks, or a profound neurapraxia associated with impairment of unilateral face and tongue motor pathways is unknown.…”

Section: Discussionsupporting

confidence: 75%

Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex

Benifla¹,

Sala

Jane

et al. 2009

PED

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Object The authors undertook this study to review their experience with cortical resections in the rolandic region in children with intractable epilepsy. Methods The authors retrospectively reviewed the medical records obtained in 22 children with intractable epilepsy arising from the rolandic region. All patients underwent preoperative electroencephalography (EEG), MR imaging, prolonged video-EEG recordings, functional MR imaging, magnetoencephalography, and in some instances PET/SPECT studies. In 21 patients invasive subdural grid and depth electrode monitoring was performed. Resection of the epileptogenic zones in the rolandic region was undertaken in all cases. Seizure outcome was graded according to the Engel classification. Functional outcome was determined using validated outcome scores. Results There were 10 girls and 12 boys, whose mean age at seizure onset was 3.2 years. The mean age at surgery was 10 years. Seizure duration prior to surgery was a mean of 7.4 years. Nine patients had preoperative hemiparesis. Neuropsychological testing revealed impairment in some domains in 19 patients in whom evaluation was possible. Magnetic resonance imaging abnormalities were identified in 19 patients. Magnetoencephalography was performed in all patients and showed perirolandic spike clusters on the affected side in 20 patients. The mean duration of invasive monitoring was 4.2 days. The mean number of seizures during the period of invasive monitoring was 17. All patients underwent resection that involved primary motor and/or sensory cortex. The most common pathological entity encountered was cortical dysplasia, in 13 children. Immediately postoperatively, 20 patients had differing degrees of hemiparesis, from mild to severe. The hemiparesis improved in all affected patients by 3–6 months postoperatively. With a mean follow-up of 4.1 years (minimum 2 years), seizure outcome in 14 children (64%) was Engel Class I and seizure outcome in 4 (18%) was Engel Class II. In this series, seizure outcome following perirolandic resection was intimately related to the child's age at the time of surgery. By univariate logistic regression analysis, age at surgery was a statistically significant factor predicting seizure outcome (p < 0.024). Conclusions Resection of rolandic cortex for intractable epilepsy is possible with expected morbidity. Accurate mapping of regions of functional cortex and epileptogenic zones may lead to improved seizure outcome in children with intractable rolandic epilepsy. It is important to counsel patients and families preoperatively to prepare them for possible worsened functional outcome involving motor, sensory and/or language pathways.

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Section: Discussionsupporting

confidence: 75%

Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex

Benifla¹,

Sala

Jane

et al. 2009

PED

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“…Although no previous studies have directly compared outcome from patients with normal and abnormal neuroimaging, our findings in patients with normal neuroimaging are largely in keeping with those of other investigators. [3][4][5][6][7][8] The answer to whether it is worth pursuing surgery in patients with normal MRI requires consideration of several factors apart from seizure control. If intracranial recordings are necessary in these patients, financial issues and the risk of complications from intracranial implantations should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports on small series of patients have suggested that the majority of patients with normal neuroimaging remain seizure-free or enjoy a more than 90% reduction in seizures after temporal lobe, 3 4 , extratemporal, 4 5 or peri-rolandic surgery. 6 A larger study on 115 patients appeared to confirm these findings. 7 In extratemporal epilepsy, good results have been reported in MRI negative patients, 8 although the presence of a focal abnormality on neuroimaging appears to be a favourable prognostic sign in frontal lobe epilepsy surgery.…”

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confidence: 85%

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Is it worth pursuing surgery for epilepsy in patients with normal neuroimaging?

Alarcón

Valentin²,

Watt³

et al. 2006

Journal of Neurology, Neurosurgery & Psychiatry

112

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“…It has been reported that patients selected for intracranial monitoring with subdural grids are less likely to have excellent outcomes because of their inherent complexity (non-concordant preoperative data, non-lesional MRI, or close relationship with eloquent cortex) [47][48][49][50][51]. This population of patients is heterogeneous, and the analysis process itself is dynamic and changes over time.…”

Section: Discussionmentioning

confidence: 99%