Generalized seizures presurgically in a cohort of children with hemispherectomy: Predictors and a potential link to surgical outcome?

Ming, Liu; Ji, Taoyun; Liu, Qingzhu; Wang, Shuang; Wu, Ye; Wang, Wen; Cheng, Wen-Tao; Wang, Ruofan; Yu, Guojing; Liu, Xiaoyan; Cai, Lixin; Jiang, Yuwu

doi:10.1016/j.seizure.2018.03.024

Cited by 11 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our case series includes 14 patients, the largest single center cohort of patients to have undergone resective surgery for ESES. Similar to other reports, most patients received hemispherotomy surgery (10/14) (23,(25)(26)(27)(28)47). The seizure outcomes for the hemispherotomy subgroup are universally excellent with seizure freedom achieved in all patients.…”

Section: Clinical Outcomessupporting

confidence: 81%

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

et al. 2020

View full text Add to dashboard Cite

Background: Electrical Status Epilepticus in Sleep (ESES) is an epileptic encephalopathy syndrome characterized by infrequent clinical seizures and prominent interictal burden during slow wave sleep associated with cognitive deficits and behavioral dysfunction. Medical treatment with anti-epileptic drugs is often unsuccessful. Resective surgery may be a valuable option in carefully selected patients. This case series aims to describe the indications, long term results and utility of resective surgery for ESES. Methods: Information on 14 patients who underwent surgery for epilepsy and ESES at the Children's Hospital of Wisconsin between 2007 and 2017 is included. Clinical, electrographic and neuropsychological features and outcomes are described in detail. Results: The most common pathology was encephalomalacia due to perinatal middle cerebral artery stoke (5/14). Twelve patients had imaging findings of perinatal pathologies; however, two patients had normal magnetic resonance imaging. Surgery was performed to control refractory epilepsy in eight patients. Six patients had no clinical seizures for 1-6 years prior to surgery, one of which had no known clinical seizures at all. All showed cognitive declines (6/14) or impairment (8/14) on neuropsychological assessments, and surgery was suggested to minimize further cognitive declines. The most common surgical procedure was hemispherotomy (10/14). Temporo-parieto-occipital disconnection, frontal lobectomy, parieto-occipital resection, and limited corticectomy were also used, with good outcomes for the first three procedures. Clinical follow up mean was 4.4 years and 12 patients had excellent seizure outcome. Electroencephalography (EEG) follow up mean was 3 years and ESES resolved in 12/14 patients. All patients completed post-surgical neuropsychological evaluation with mean follow-up of 17.46 months. Conclusions: Resective surgery is an effective treatment for selected cases of ESES, producing long term seizure freedom, resolution of ESES and stabilization of cognitive and behavioral functioning in most patients. Our case series is the largest single center cohort description addressing resective surgery for ESES. Outcomes in this sample Marashly et al. Resective Epilepsy Surgery for ESES suggest that good long-term seizure, EEG and cognitive/behavioral outcomes can be achieved in patients with normal brain imaging and in limited lobar or multi-lobar resections. Moreover, patients with ESES and very infrequent clinical seizures can benefit from surgery with stabilization of cognitive and behavioral functioning.

show abstract

Section: Clinical Outcomessupporting

confidence: 81%

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Abnormalities were extensive, involving all aspects of the frontal lobe (basal-medial-lateral) and extending up to the primary motor-sensory strip and anterior insula. Several series of young pediatric cases, across a variety of substrates, have shown that the presence of an encephalopathic background with "generalized" and "diffuse" interictal and ictal EEG features should not, on its own, be prohibitive for resective surgery, in case a well-defined epileptogenic lesion can be imaged [17][18][19][20][21] especially if, at least some EEG "clues" for a lesion-concordant lateralization exist. 22,23 Given this background knowledge, and despite the absence of clear lateralizing/localizing EEG and semiological features, we opted for a generous frontal lobectomy.…”

Section: Discussionmentioning

confidence: 99%

Frontal lobe epilepsy and mild malformation with oligodendroglial hyperplasia: Further observations on electroclinical and imaging phenotypes, and surgical perspectives

Garganis

Gkiatis

Maletić

et al. 2023

Epileptic Disorders

View full text Add to dashboard Cite

Objective Mild malformation with oligodendroglial hyperplasia (MOGHE) is a recently described clinicopathologic entity, associated with drug‐resistant epilepsy and extensive epileptogenic networks. Knowledge is accumulating about particular electroclinical phenotypes, correlations with imaging, and potential prognostic significance for surgical outcomes. The study adds relevant information by documenting the presence of a hyperkinetic frontal lobe seizure phenotype in adolescents and an epileptic encephalopathy phenotype in young children. Methods Five cases were subjected to a structured presurgical evaluation protocol, including EEG‐FMRI, chronic and acute invasive EEG, subjected to frontal lobe surgery with postoperative follow‐up between 15 months and 7 years. Results In the two adult cases, surface EEG demonstrated lateralized widespread frontal lobe epileptogenicity and hyperkinetic semiological features. MRI demonstrated cortical white matter blurring and deeper white matter abnormalities. EEG‐FMRI suggested concordant frontal lobe involvement. iEEG demonstrated a widespread frontal lobe epilepsy network. The three young children demonstrated a diffuse epileptic encephalopathy phenotype, with nonlocalizing, nonlateralizing surface EEG, and “spasms” as the main seizure type. MRI demonstrated extensive frontal lobe subcortical gray and white matter abnormalities, consistent with MOGHE literature for this age, while EEG‐FMRI, in 2/3, demonstrated concordant frontal lobe involvement. They did not undergo chronic iEEG, and the resection was assisted by acute intraoperative ECoG. All cases were subjected to extensive frontal lobectomies with Engel class IA (2/5), IB (1/5), and IIB (2/5) outcomes. Significance The study confirms the presence of frontal lobe epilepsy and epileptic encephalopathy phenotypes, in accordance with epilepsy phenotypes already described in MOGHE literature. Presurgical evaluation studies, including EEG‐FMRI, can provide strong lateralizing and localizing evidence of the epileptogenic networks involved. All responded favorably to extensive frontal lobe resections, despite widespread epileptic activity recorded by surface and intracranial EEG pre‐ and postoperatively; an epileptic encephalopathy phenotype, in the first years of life, should not discourage such a resection.

show abstract

“…It is generally assumed that a focal semiology (e.g. clonic arm movements contralateral to the affected hemisphere) is another data point that supports pursuing HDS while generalized seizures may portend lower rates of seizure freedom post-hemispherotomy (Carmant et al, 1995;Liu et al, 2018). If the lateralization of seizure onset is still in question after obtaining brain MRI and EEG, then PET, ictal SPECT (SISCOM), and/or MEG/MSI may play a role in lateralizing seizure onset.…”

Section: Discussionmentioning

confidence: 99%

An algorithmic approach to preoperative studies and patient selection for hemispheric disconnection surgery: a literature review

Tomycz¹,

Hale

Abdulrazeq

et al. 2020

Epileptic Disorders

View full text Add to dashboard Cite

Hemispheric disconnection surgery (HDS) is one of the most effective surgical options for appropriate candidates with medicallyrefractory epilepsy (MRE) in whom most or all seizures arise from diffuse areas within a single hemisphere. While there are several well-accepted indications for HDS, there are additional patients who may benefit from HDS. However, there are no standardized recommendations for how preoperative studies should be used to identify appropriate candidates for HDS. We aimed to propose an algorithmic approach for presurgical evaluation in order to guide appropriate implementation of HDS for either cure or palliation of severe MRE in infants, children, and adults. Methods. We performed a qualitative review of the literature using PubMed, the Cochrane Library, and Google Scholar to select primary articles addressing imaging modalities used for the presurgical evaluation of patients with MRE being considered for HDS. Results. In total, we identified 126 articles that met our inclusion criteria. We propose a framework to guide candidate selection for HDS that incorporates various elements of the clinical presentation, electroencephalographic analysis, and neuroimaging. While this approach still requires prospective validation, the authors feel it is grounded in a synthesis of the best available evidence in the literature and informed by expert opinion. Conclusions. HDS is a powerful tool in the armamentarium of experienced multidisciplinary epilepsy centers to treat patients with severe MRE arising from diffuse areas constrained to a single hemisphere. The under-utilization of epilepsy surgery may be, in part, remedied by establishing evidence-based pathways for presurgical analyses to determine surgical candidacy.

show abstract

Generalized seizures presurgically in a cohort of children with hemispherectomy: Predictors and a potential link to surgical outcome?

Cited by 11 publications

References 21 publications

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

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

Frontal lobe epilepsy and mild malformation with oligodendroglial hyperplasia: Further observations on electroclinical and imaging phenotypes, and surgical perspectives

An algorithmic approach to preoperative studies and patient selection for hemispheric disconnection surgery: a literature review

Contact Info

Product

Resources

About