Multimodal localization and surgery for epileptic spasms of focal origin: a review

Abstract

<jats:p>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. Increased awareness of ES as a potentially focal epilepsy, along with advances in neuroimaging and invasive monitoring technologies, have led to the ability to surgically treat many patients with ES who were previously not considered surgical candidates. In this study, the authors review the current state of epilepsy surgery for ES. Specifically, they address how advances in neuroimaging and invasive monitoring have facilitated patient selection, presurgical evaluation, and ultimately, resection planning.</jats:p>

Stereoelectroencephalography Versus Subdural Electrodes for Localization of the Epileptogenic Zone: What Is the Evidence?

“…Numerous observational studies have published seizure freedom rates following resective epilepsy surgery guided by SEEG or SDE [19,27,[59][60][61][62]. Table 3 describes many recently published large cohort studies evaluating seizure freedom with the use of SEEG or SDE [45,49,52,60,63,[64][65][66][67][68].…”

Early surgical intervention for structural infantile spasms in two patients under 6 months old: a case report

“…In the presence of more than four factors, 91% were found to be surgical candidates [6]. Therefore, early surgery is recommended for those who are suitable for surgery in order to avoid intellectual and cognitive deterioration [7,8]. The surgical treatment of IS mainly includes two methods: resection and palliative surgery.…”

“…The resection surgery is preferred for patients with definite etiology, focal seizures and an origin located in the non-functional areas [4]. The palliative surgery, which mainly cuts the corpus callosum, can be used for those who have no clear etiology or manifesting widely disseminated epileptiform discharges; neuromodulation techniques such as vagus nerve stimulation (VNS) and deep brain stimulation can also be considered [8,9]. Delphine et al [10] reported three such patients who presented with IS between 5 and 7 months of age; two of the patients who underwent early hemispherotomy acquired normal verbal intelligence, whereas the third patient, who was the oldest and had the longest duration of epilepsy, was operated on at 38 months of age and remained with severe mental retardation.…”

Patterns and predictors of language representation and the influence of epilepsy surgery on language reorganization in children and young adults with focal lesional epilepsy

“…In line with this observation, patients with normal EEG and seizure freedom after surgery exhibited a more typical postoperative language representation. Although localized ictal onset on scalp EEG is a well-recognized predictor of favorable seizure outcome [ 1 ], several studies have suggested that early surgery can be beneficial also in patients with focal lesions but diffuse epileptogenicity [ 75 – 77 ]. Our observation that focal lesional epilepsy associated with diffuse EEG abnormalities may lead to atypical language lateralization and worse cognitive performances, which are potentially reversible after successful surgery, further supports this view.…”