Stereotactic radiotherapy instead of conventional epilepsy surgery

Heikkinen, E; Heikkinen, Mirja; Sotaniemi, K. A.

doi:10.1007/bf01541801

“…Decrease in seizure frequency after radiosurgery seems to develop progressively. The majority of patients records the first signs of improvement after a period of time, ranging between several weeks and 1 year [16,18], and the changes stabilize progressively during a period lasting several months. However, some cases of an immediate transient cessation of seizures after radiosurgery have been recorded.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports indicate the beneficial effect of palliative irradiation of different brain lesions on the secondary seizures, even before the primary lesion resolves [1][2][3][4][11][12][13][14][15]. Furthermore, stereotactic radiosurgery' with low doses has been used for specific treatment of medically resistant epilepsy as an alternative to conventional resective surgery [7,[16][17][18], Additionally focal irradiation has been proven to be effective in experimental studies in animal models of chronic epilepsy [5,19].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery May Be Effective in the Treatment of Idiopathic Epilepsy: Report on the Methods and Results in a Series of Eleven Cases

Barcia

¹

,

Barcia-Salorio

²

,

Lopez-Gomez

³

et al. 1994

Stereotact Funct Neurosurg

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Between 1982 and 1991, 11 patients (4 male, 7 female) ranging in age from 16 to 42 years who had been diagnosed with idiopathic focal epilepsy resistant to medication, were treated with stereotactic radiosurgery. The preoperative symptomatic period was 3–24 years. The process of localizing epileptic focus was based on chronic electrocorticography with flexible electrodes introduced into the subarachnoid space through single burr holes, and left in place during a maximum of 7 days until a clinical seizure was recorded. In most cases the procedure had to be repeated until localization was clear. This process was aided by a computer-assisted automatic analysis procedure. Final confirmation of focus location was done with depth electrode recording in most cases. Stereotactic radiosurgery was performed with a ⁶⁰Co gamma source using 10 mm collimators, except in two cases in which a betatron was used. The estimated dose was 10–20 Gy at the isocenter. Four of the 11 patients (36%) were medication-and seizure-free after a mean follow-up of 102.5 months. Five patients (45%) presented a reduction of seizures of 98, 89, 86, 75 and 75%, respectively. Two patients did not respond to treatment. Seizure reduction began after a delay period of 2–12 months except in 2 patients and in most cases seizure rate decreased progressively during several months (range: 3–48) postoperatively until stabilization. No complications related to irradiation were recorded. Doses effective for epilepsy are much lower than those for producing cerebral lesions, so the mechanism is not destruction of the focus or the pathways spreading the epileptic activity. It may be an effect upon neurotransmitters involved in epilepsy mechanisms, or an indirect effect through changes in the glial cells or by local plasticity phenomena.

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“…3.02% of all subjects had a family history of epilepsy and 76 (10.43%) had a history of fever convulsion. (2) Patients with one seizure type were about 25.14% and with two or more seizure types were about 74.86%. The main seizure types were complex partial seizures (67.44%) and generalised tonicclonic seizures (69.50%), and a majority of generalised tonic-clonic seizures were secondary (88.14%).…”

Section: Purposementioning

confidence: 98%

Monday July 3, 2006 15:00-17:00 Hall 3A Discussion Group Session Cognitive dysfunction in children with temporal lobe epilepsy

2006

Epilepsia

0

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Purpose: This study was designed to compare monotherapy with sodium valproate (VPA) and lamotrigine (LTG) in patients with newly diagnosed epilepsy.Method: A total of 226 untreated patients (116 male) with a recent diagnosis of epilepsy (60 idiopathic generalised epilepsy, 149 localisationrelated epilepsy, 17 unclassified) were randomised to receive either VPA or LTG as monotherapy. Median age was 35 years (range 13-80 years). Patients were followed-up at six-weekly intervals and remained in the study until reaching a predetermined end point (12 month seizurefreedom; intolerable side-effects including idiosyncratic reaction; lack of efficacy despite adequate dosing).Results: Twenty-nine patients were excluded from the analysis (24 lost to follow-up, 3 withdrawn consent, 1 protocol violator, 1 nonepileptic attack). A total of 197 patients reached an end point, with 126 (63%) becoming seizure-free for a minimum period of 12 months on initial monotherapy. Of these, 64 took VPA (67% of VPA completers; median dose = 1000 mg, range 600-3000 mg) and 62 took LTG (60% of LTG completers; median dose = 200 mg, range 100-700 mg). Thirty-eight patients (24 VPA, 14 LTG) experienced intolerable side effects, while a further 33 (18 VPA, 15 LTG) failed to report acceptable efficacy despite adequate dosing. There were no significant changes in mean (±SEM) serum concentrations of testosterone (p = 0.225), SHBG (p = 0.201), or androstenedione (p = 0.394) in either patient group at 6 months after initiation of therapy.Conclusion: These findings suggest that there is little (if any) difference in the efficacy, tolerability, or hormonal effects of VPA or LTG monotherapy in the treatment of newly diagnosed epilepsy.Purpose: There is a paucity of randomised controlled trials (RCTs) that inform a choice among antiepileptic drugs, and existing trials have largely failed to examine longer term effectiveness. SANAD assesses these longer term outcomes.Method: SANAD is a multicentre, UK based, unblinded RCT recruiting patients over the age of 5 years, requiring antiepileptic drug monotherapy. SANAD has 2 arms. Patients for whom carbamazepine was the standard drug (arm A) were randomised to carbamazepine, gabapentin, lamotrigine, oxcarbazepine or topiramate. Patients for whom valproate was the standard drug (arm B) were randomised to valproate, lamotrigine or topiramate. Recruitment commenced in 1999, ended 2005, and follow up ended in 2005. Outcomes included time to the following events: withdrawal of allocated treatment, 12 month remission from seizures, first seizure, as well as adverse events, quality of life and cost effectiveness.Results: 2443 patients were recruited, for whom we have 7799 patient years follow up, 95% of the maximum possible. 1721 patients entered arm A, 378 were allocated carbamazepine, 377 gabapentin, 378 lamotrigine, 210 oxcarbazepine and 378 topiramate. The mean age was 38.3 yrs, 55% were male and 89% were classified as having a partial epilepsy syndrome. 716 patients entered arm B, 238 were allocated valproate, 239 l...

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“…Reorganisation of neuropsychological functions, particularly regarding verbal competences, was observed especially in patients with extensive resections. 1 E. Sager Magnusson, 1 G. Ekstedt, 2 C. Taft, and 1 K. Malmgren ( 1 Epilepsy Research Group, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden, 2 Health Care Research Unit, Institute of Medicine, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden) Purpose: To prospectively assess and compare the health-related quality of life (HRQL) of adults evaluated for epilepsy surgery: 1) in operated versus nonoperated patients, 2) in operated seizure-free versus seizurepersistent patients, and 3) with population norms.…”

Section: Selective Amobarbital Test In the Anterior Choroidal Artery:mentioning

confidence: 99%

Monday July 3, 2006 13:30-15:00 Poster Session 1 Psychiatry

2006

Epilepsia

5

0

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Purpose: This study was designed to compare monotherapy with sodium valproate (VPA) and lamotrigine (LTG) in patients with newly diagnosed epilepsy.Method: A total of 226 untreated patients (116 male) with a recent diagnosis of epilepsy (60 idiopathic generalised epilepsy, 149 localisationrelated epilepsy, 17 unclassified) were randomised to receive either VPA or LTG as monotherapy. Median age was 35 years (range 13-80 years). Patients were followed-up at six-weekly intervals and remained in the study until reaching a predetermined end point (12 month seizurefreedom; intolerable side-effects including idiosyncratic reaction; lack of efficacy despite adequate dosing).Results: Twenty-nine patients were excluded from the analysis (24 lost to follow-up, 3 withdrawn consent, 1 protocol violator, 1 nonepileptic attack). A total of 197 patients reached an end point, with 126 (63%) becoming seizure-free for a minimum period of 12 months on initial monotherapy. Of these, 64 took VPA (67% of VPA completers; median dose = 1000 mg, range 600-3000 mg) and 62 took LTG (60% of LTG completers; median dose = 200 mg, range 100-700 mg). Thirty-eight patients (24 VPA, 14 LTG) experienced intolerable side effects, while a further 33 (18 VPA, 15 LTG) failed to report acceptable efficacy despite adequate dosing. There were no significant changes in mean (±SEM) serum concentrations of testosterone (p = 0.225), SHBG (p = 0.201), or androstenedione (p = 0.394) in either patient group at 6 months after initiation of therapy.Conclusion: These findings suggest that there is little (if any) difference in the efficacy, tolerability, or hormonal effects of VPA or LTG monotherapy in the treatment of newly diagnosed epilepsy.Purpose: There is a paucity of randomised controlled trials (RCTs) that inform a choice among antiepileptic drugs, and existing trials have largely failed to examine longer term effectiveness. SANAD assesses these longer term outcomes.Method: SANAD is a multicentre, UK based, unblinded RCT recruiting patients over the age of 5 years, requiring antiepileptic drug monotherapy. SANAD has 2 arms. Patients for whom carbamazepine was the standard drug (arm A) were randomised to carbamazepine, gabapentin, lamotrigine, oxcarbazepine or topiramate. Patients for whom valproate was the standard drug (arm B) were randomised to valproate, lamotrigine or topiramate. Recruitment commenced in 1999, ended 2005, and follow up ended in 2005. Outcomes included time to the following events: withdrawal of allocated treatment, 12 month remission from seizures, first seizure, as well as adverse events, quality of life and cost effectiveness.Results: 2443 patients were recruited, for whom we have 7799 patient years follow up, 95% of the maximum possible. 1721 patients entered arm A, 378 were allocated carbamazepine, 377 gabapentin, 378 lamotrigine, 210 oxcarbazepine and 378 topiramate. The mean age was 38.3 yrs, 55% were male and 89% were classified as having a partial epilepsy syndrome. 716 patients entered arm B, 238 were allocated valproate, 239 l...

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Stereotactic radiotherapy instead of conventional epilepsy surgery

Cited by 43 publications

References 10 publications

Stereotactic Radiosurgery May Be Effective in the Treatment of Idiopathic Epilepsy: Report on the Methods and Results in a Series of Eleven Cases

Stereotactic Radiosurgery May Be Effective in the Treatment of Idiopathic Epilepsy: Report on the Methods and Results in a Series of Eleven Cases

Monday July 3, 2006 15:00-17:00 Hall 3A Discussion Group Session Cognitive dysfunction in children with temporal lobe epilepsy

Monday July 3, 2006 13:30-15:00 Poster Session 1 Psychiatry

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Stereotactic radiotherapy instead of conventional epilepsy surgery

Cited by 43 publications

References 10 publications

Stereotactic Radiosurgery May Be Effective in the Treatment of Idiopathic Epilepsy: Report on the Methods and Results in a Series of Eleven Cases

Stereotactic Radiosurgery May Be Effective in the Treatment of Idiopathic Epilepsy: Report on the Methods and Results in a Series of Eleven Cases

Monday July 3, 2006 15:00-17:00 Hall 3A Discussion Group Session Cognitive dysfunction in children with temporal lobe epilepsy

Monday July 3, 2006 13:30-15:00 Poster Session 1 Psychiatry

Contact Info

Product

Resources

About

Monday July 3, 2006 15:00-17:00 Hall 3A Discussion Group Session Cognitive dysfunction in children with temporal lobe epilepsy

Monday July 3, 2006 13:30-15:00 Poster Session 1 Psychiatry