Multiple subpial transection: a review of 21 cases.

Sawhney, I. M. S.; Robertson, Iain; Polkey, Charles E.; Binnie, C.D.; Elwes, Robert

doi:10.1136/jnnp.58.3.344

Cited by 122 publications

(49 citation statements)

References 22 publications

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“…The approach was conceived and advocated for the specific situation in which resective surgery was precluded by the likelihood of neurologic compromise, and was later adapted for the treatment of some specific syndromes (2,3). Subsequently MST has been slowly (and somewhat randomly) adopted at many centers around the world, some of which have published experience with specific patient selection, seizure outcome, and neurologic status (4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Multiple Subpial Transection for Intractable Partial Epilepsy: An International Meta‐analysis

Spencer¹,

Schramm²,

Wyler

et al. 2002

Epilepsia

167

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Summary:Purpose: Because the number and variety of patients at any single facility is not sufficient for clinical or statistical analysis, data from six major epilepsy centers that performed multiple subpial transections (MSTs) for medically intractable epilepsy were collected.Methods: A meta-analysis was performed to elucidate the indications and outcome, and to assess the results of the procedure. Overall, 211 patients were represented with data regarding preoperative evaluation, procedures, seizure types and frequencies before and after surgery, postoperative deficits, and demographic information. Fifty-three patients underwent MST without resection.Results: In patients with MST plus resection, excellent outcome (>95% reduction in seizure frequency) was obtained in 87% of patients for generalized seizures, 68% for complex partial seizures, and 68% for simple partial seizures. For the patients who underwent MST without resection, the rate of excellent outcome was only slightly lower, at 71% for generalized, 62% for complex partial, and 63% for simple partial seizures. EEG localization, age at epilepsy onset, duration of epilepsy, and location of MST were not significant predictors of outcome for any kinds of seizures after MST, with or without resection. New neurologic deficits were found in 47 patients overall, comparable in MST with resection (23%) or without (19%).Conclusions: These preliminary results suggest that MST has efficacy by itself, with minimal neurologic compromise, in cases in which resective surgery cannot be used to treat uncontrolled epilepsy. MST should be investigated as a stand-alone procedure to allow further development of criteria and predictive factors for outcome. Key Words: Epilepsy surgeryMultiple subpial transection-MST-Refractory epilepsy.Based on anatomic and functional considerations, and on physiological observations in animal models, Morrell et al. (1) introduced the procedure of multiple subpial transections (MSTs) for the treatment of medically uncontrolled epilepsy. The approach was conceived and advocated for the specific situation in which resective surgery was precluded by the likelihood of neurologic compromise, and was later adapted for the treatment of some specific syndromes (2,3). Subsequently MST has been slowly (and somewhat randomly) adopted at many centers around the world, some of which have published experience with specific patient selection, seizure outcome, and neurologic status (4-13).A confounding aspect of such reports is the tendency to combine MST with some cortical resection, such that the efficacy and the neurologic compromise associated with either component of the approach cannot easily be separately assessed. The variable nature and distribution of underlying substrate, coupled with small numbers of patients at any one center, limit valid multivariable analyses of factors predictive of response, or even a consideration of differential efficacy. Whether MST provides substantial reduction in a specific seizure type, whether this benefit is achieved...

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Section: Discussionmentioning

confidence: 99%

Multiple Subpial Transection for Intractable Partial Epilepsy: An International Meta‐analysis

Spencer¹,

Schramm²,

Wyler

et al. 2002

Epilepsia

167

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“…3,[40][41][42] Most patients who have undergone multiple subpial transections in eloquent brain tissue have had subtle and transient postoperative deficits that correspond to the transected areas and are most pronounced in the first week after surgery. 19,30,48,60,63 Corpus callosotomy is another palliative treatment that may be beneficial for patients with multiple or poorly lateralized epileptogenic foci, secondarily generalized tonicclonic seizures, and injurious drop attacks (those that result in falls and injury) due to tonic or atonic seizures. 67,68,79 Elimination or a more than 80% reduction in seizures has been reported in 70% of patients who underwent this treatment.…”

Section: Neurosurg Focus / Volume 21/ July 2006mentioning

confidence: 99%

Cerebral cavernous malformations and epilepsy

Awad¹,

Jabbour²

2006

FOC

148

117

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✓Seizures and epilepsy are frequent clinical manifestations of cerebral cavernous malformations (CCMs) and represent the most common symptomatic presentation of supratentorial lesions. Clinicians often diagnose CCMs in patients after a first seizure, or in some cases after obtaining neuroimaging studies in patients suffering from chronic epilepsy previously thought to be idiopathic. In some cases, the lesion is clinically significant solely because of its epileptogenicity, but in others there may be concern about potential hemorrhage or focal neurological deficits from a similar lesion. The authors present current pathophysiological concepts related to epilepsy associated with CCMs. They discuss the spectrum of seizure disorders associated with these lesions and review the natural history, prognosis, and options for therapeutic intervention.

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“…The procedure is increasingly popular (21)(22)(23) and involves making multiple vertical cuts in an epileptogenic region of cortex in an attempt to impede seizure initiation and propagation. Our work suggests that it might be possible to make more targeted and selective subpial transections that maximize the anticonvulsant effect while minimizing the impairment of critical cortical functions.…”

Section: Cortical Cutsmentioning

confidence: 99%

Layer‐Specific Pathways for the Horizontal Propagation of Epileptiform Discharges in Neocortex

1998

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Summary: Purpose: Epileptiform discharges that resemble interictal spikes can be generated by slices of neocortex treated with antagonists of y-aminobutyric acid A (GABA,) receptors. These discharges can propagate horizontally for long distances. We tested the hypothesis that propagation occurs through preferred horizontal pathways that lie in a particular cortical layer.Methods: Slices were prepared from the primary somatosensory cortex of rats, maintained in vitro, and bathed with the GABA, receptor antagonist picrotoxin. Electrical stimuli were used to evoke single all-or-none paroxysmal field potentials (PFP) that were recorded with pairs or arrays of field potential electrodes.Results: To test which laminae are necessary for propagation, vertical cuts were made to force the PFF' to spread horizontally through particular layers. If slices were bathed in a high dose of picrotoxin (35 m, a bridge of cortex 350 Fm thick placed at any lamina was sufficient to support PFP propagation. However, in low picrotoxin doses (2.5 CLIK), similarly sized bridges had to include tissue from layers 415 or 516 to support propagation. When slices were cut horizontally (i.e., parallel to the pia) in strips, either upper-, middle-, or lowerlayer strips were sufficient to support PFP propagation if the picrotoxin concentration was high; however, in low picrotoxin doses, only horizontal strips that included layer 5 could support propagation. Finally, in intact picrotoxin-treated slices, focal applications of GABA were systematically applied to different laminae as the PFP propagated past; GABA was most effective at blocking or delaying propagation when it was applied to layer 5b.Conclusions: We conclude that epileptiform propagation can occur through a variety of horizontal pathways when cortical inhibition is strongly impaired. However, when inhibition is reduced only moderately, axonal pathways in layer 5 are critical for seizure spread.

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Multiple subpial transection: a review of 21 cases.

Cited by 122 publications

References 22 publications

Multiple Subpial Transection for Intractable Partial Epilepsy: An International Meta‐analysis

Multiple Subpial Transection for Intractable Partial Epilepsy: An International Meta‐analysis

Cerebral cavernous malformations and epilepsy

Layer‐Specific Pathways for the Horizontal Propagation of Epileptiform Discharges in Neocortex

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