Epilepsy surgery for epileptic encephalopathy as a sequela of herpes simplex encephalitis: case report

Abstract

<jats:p>Herpes simplex virus (HSV) encephalitis can manifest with different clinical presentations, including acute monophasic illness and biphasic chronic granulomatous HSV encephalitis. Chronic encephalitis is much less common, and very rare late relapses are associated with intractable epilepsy and progressive neurological deficits with or without evidence of HSV in the cerebrospinal fluid. The authors report on an 8-year-old girl with a history of treated HSV-1 encephalitis when she was 13 months of age and focal epilepsy when she was 2 years old. Although free of clinical seizures, when she was 5, she experienced behavioral and academic dysfunction, which was later attributed to electrographic focal seizures and worsening electroencephalography (EEG) findings with electrical status epilepticus during slow-wave sleep (ESES). Following a right temporal lobectomy, chronic granulomatous encephalitis was diagnosed. The patient's clinical course improved with the resolution of seizures and EEG abnormalities.</jats:p>

Examining the Utility of Resective Epilepsy Surgery in Children With Electrical Status Epilepticus in Sleep: Long Term Clinical and Electrophysiological Outcomes

“…Our results are consistent with the available literature for outcomes related to hemispherotomy. Our data also adds to the limited prior report of patients who responded favorably to limited resective surgeries including temporal lobectomy (24), temporo-parieto-occipital resection (23), and frontal lobectomy (28).…”

“…This series also demonstrates the long-term effect of surgery on the EEG with seven patients continuing to show resolution of ESES beyond 2 years. This prolonged EEG improvement has been rarely reported before (24,25) as most previous studies had EEG follow up <2 years post-operatively or did not elaborate on the length of the follow up (23,26,27).…”

“…Although patients with ESES are known to have low seizure frequency, most patients undergoing surgery described in the literature had a high seizure burden, sometimes daily (23,(25)(26)(27) and only few had infrequent or no seizures for all or part of the ESES course (24,28). This is the first study to report a high number of patients (6/14) with rare or no clinical seizures responding to surgery from an electrographic and neuropsychological standpoints.…”

“…Resective surgery is an alternative to medical therapies, especially in cases of ESES associated with brain lesions. Despite the lack of robust comparative studies, the clinical and electrographic outcomes of the reported surgical series seem to outperform the outcomes of any other medical therapy (7,(23)(24)(25)(26)(27)(28). A recent meta-analysis of the different treatment options showed improvement in either Electroencephalography (EEG) or cognitive functioning in response to benzodiazepines in 68% of patients; to steroids in 81%, and to surgery in 90% of patients vs. improvement in only 49% of patients in response to traditional Anti-epileptic Drugs (AEDs) (29).…”

“…In most of the surgical series mentioned above, patients underwent surgery to control refractory seizures and ESES. Only rarely was surgery performed in the setting of rare or no seizures and ESES (24,28).…”