Outcome after extended callosal section in patients with primary idiopathic generalized epilepsy

Cukiert, Arthur; Burattini, José Augusto; Mariani, Pedro Paulo; Cukiert, Cristine Mella; Argentoni-Baldochi, Meire; Baise-Zung, Carla; Forster, Cássio; Mello, Valeria Antakli

doi:10.1111/j.1528-1167.2008.01875.x

Cited by 31 publications

(12 citation statements)

References 16 publications

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“…With regard to QOL and IQ, postoperative improvement was found in patients with RGE and MR, similar to the outcomes of prior series [16,21,26] . These improvements may be a result of disrupted propagation of abnormal electrical activity between the hemispheres.…”

Section: Discussionsupporting

confidence: 70%

Anterior Corpus Callosotomy in Patients with Intractable Generalized Epilepsy and Mental Retardation

Liang¹,

Li²,

Jiang³

et al. 2010

Stereotact Funct Neurosurg

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Aims: To prospectively study outcomes of anterior corpus callosotomy (aCCT) in patients with refractory generalized epilepsy (RGE) and mental retardation (MR), and estimate the effect of preoperative Wechsler Full Scale Intelligence Quotient (FIQ) on surgical outcomes. Methods: Selected patients with RGE were divided into a moderate MR group (MoMR), mild MR group (MiMR) and no MR group (NMR), and all of them were treated with aCCT. Seizure outcomes were evaluated at the 1-year follow-up (1FU) and 2-year follow-up (2FU), and changes of quality of life (QOL) and IQ were tested at 2FU. Results: Seizure control did not differ by group or follow-up period. Most seizure reduction was achieved in atonic or tonic seizures with 76–80% reduction at 1FU and 81–87% at 2FU; myoclonic epilepsy was the least likely to respond. QOL changes differed among groups, and 53.2% of total patients showed postoperative QOL improvement: 75% in the MoMR group, 65% in the MiMR group and 21.1% in the NMR group. No significant group difference was seen in FIQ change, although average postoperative performance IQ (PIQ) improvement in patients with MR exceeded 4 points. Conclusion: aCCT can reduce seizures and is a safe surgical procedure. Low IQ does not affect seizure outcome and can be associated with a good surgical outcome in PIQ and QOL improvement.

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Section: Discussionsupporting

confidence: 70%

Anterior Corpus Callosotomy in Patients with Intractable Generalized Epilepsy and Mental Retardation

Liang¹,

Li²,

Jiang³

et al. 2010

Stereotact Funct Neurosurg

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“…Seizure outcome was poor when CCT was used in TSC to control epilepsy as the exclusive surgical approach (Madhavan et al., 2007a,b; Jansen et al., 2007b). Outcome of this cohort showed obvious improvement of QOL and PIQ in patients with CCT, which was similar to the outcome obtained from prior research on CCT in patients with epilepsy and low IQ (Maehara & Shimizu, 2001; Cukiert et al., 2008). Therefore, CCT could be used as an epilepsy surgery adjunct to the resective approach for patients with TSC and low IQ when considering QOL and IQ.…”

Section: Discussionsupporting

confidence: 85%

Epilepsy surgery in tuberous sclerosis complex: Emphasis on surgical candidate and neuropsychology

Liang

Zhao

et al. 2010

Epilepsia

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SUMMARYPurpose: To discuss neuropsychological outcome and candidate of epilepsy surgery for tuberous sclerosis complex (TSC). Methods: To retrospectively analyze clinical data of 25 patients with TSC and epilepsy who underwent epilepsy surgery between 2001 and 2007. Seizure reduction was analyzed at 1-year (1FU), 2-year (2FU), and 5-year (5FU) follow-up visits after surgery, and outcomes of intelligence quotient (IQ) and quality of life (QOL) were evaluated at 2FU. Results: Resective procedures included 14 tuber resections, 9 lobectomies, and 2 tuber resections and lobectomies. Corpus callosotomies (CCTs) were performed as the adjunctive approach in eight cases with low IQ and behavioral problems. The percentages of seizure-free cases were 72% at 1FU, 60% at 2FU, and 54.5% at 5FU, and the factors predicting seizure freedom included the course of seizures and ages of patients. Significant improvement was found in performance IQ in patients with preoperative low IQ or CCT. Significant improvement in mean QOL score was observed in all patients, especially patients with preoperative low IQ and CCT but postoperative seizure freedom. Conclusion: To be surgical candidates, patients with TSC and epilepsy should have identified epileptogenic tubers, and candidates should include patients with low IQ and multiple epileptogenic tubers. Satisfactory seizure control was often achieved with early operation, whereas improved QOL was observed frequently in postoperative seizure-free patients. CCT could be performed as an adjunctive approach to resective operation for TSC patients with epilepsy and low IQ and render improvement of performance IQ and QOL.

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“…Corpus Callosotomy: There are even fewer studies that have examined the effectiveness of corpus callosotomy for medically refractory cases of JME. A case series (N=11) from Brazil [114] included GGE patients who underwent extensive one-stage callosal transections. At least 75% reduction in frequency of GTCS was noted in all patients; three patients had complete remission of absences and the other patients had a >90% reduction in the frequency of absence seizures.…”

Section: Non-medical Treatmentsmentioning

confidence: 99%

Juvenile Myoclonic Epilepsy — A Maturation Syndrome Coming of Age

Pella¹,

Mukundan²,

Szabo³

2014

Epilepsy Topics

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because primary centers achieve successful treatment via antiepileptic medications. Moreover, JME is often under-diagnosed and misdiagnosed [22, 23], which can present a challenge to estimating its prevalence. As an illustration, a French study [24] showed that the prevalence of JME in one geographic area was 0% between 1986 and 1994, which rose to nearly 50% between 1996 and 2000, likely due to increased recognition of the syndrome. Moreover, variations in clinical onset can present a challenge to estimating the prevalence of JME. Although JME the peak age of onset is in adolescence (12-18 years), similar to most GGE syndromes [10, 25], the age of onset can vary from 8 to 36 years. There are also de novo diagnoses in early adulthood, and JME can, though rarely, begin or be reactivated in advanced ages. For instance, a case report presented two patients from Turkey in whom JME began after the age of 70 [26]. 4. Clinical diagnosis Myoclonic Seizures: As noted above, myoclonic movements are one of the main symptoms of JME and consist of generalized seizures which are brief, irregular jerks of the head, trunk, and limbs that can be either symmetric or asymmetric, and may involve isolated regions of the body or the whole body. They usually predominate in the upper limbs (mostly distal muscles), although they occasionally involve muscles in the abdomen, paraspinal distributions, and lower extremity [27]. It is not uncommon for myoclonic seizures to be so subtle or brief that they are perceived as benign "inner shocks". As subtle as the may be, patients tend to more readily notice asymmetric jerks involving the dominant upper extremity because such movements noticeably impair daily functioning. The jerks, if violent, may cause the patient to drop or throw objects, or fall to the floor-which may be mistaken for nonpathological clumsiness. Myoclonic seizures can manifest as discrete, single events or they may occur in clusters. They are usually not associated with loss of consciousness but it is not uncommon for patients to lose awareness during the jerks. Moreover, clusters of myoclonic events can evolve into a GTCS and cause post-ictal confusion. They can occur during transition to sleep or during awakening from sleep, usually in the early morning hours [28]. This early morning pattern of seizures is associated with an increase in cortical excitability during that time of day, which has been noted in other patients with GGE, but to a greater extent in JME patients [29]. Developmentally, these jerks often subside in the fourth decade of life, although GTCS or absence seizures tend to persist [30]. Generalized Tonic-Clonic Seizures: About 80% of the patients with JME have GTCS. These seizures are also more likely to occur if precipitated by sleep deprivation or alcohol intake. Usually, these events are immediately preceded by a series of myoclonic jerks and associated tongue biting prior to generalization. Because, as noted above, myoclonic events are often insidious, patients first seek treatment following an initial GT...

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Outcome after extended callosal section in patients with primary idiopathic generalized epilepsy

Cited by 31 publications

References 16 publications

Anterior Corpus Callosotomy in Patients with Intractable Generalized Epilepsy and Mental Retardation

Anterior Corpus Callosotomy in Patients with Intractable Generalized Epilepsy and Mental Retardation

Epilepsy surgery in tuberous sclerosis complex: Emphasis on surgical candidate and neuropsychology

Juvenile Myoclonic Epilepsy — A Maturation Syndrome Coming of Age

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