Surgical treatment of focal symptomatic refractory status epilepticus with and without invasive EEG

Oderiz, Carolina Cuello; Aberastury, Marina; Besocke, Ana Gabriela; Sinner, Jorge; Comas-Guerrero, Betiana; Ciraolo, Carlos; Pasteris, Maria Concepción; Silva, Walter Horacio; García, María del Carmen García

doi:10.1016/j.ebcr.2015.08.005

Cited by 19 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A right anterior temporal lobectomy was planned, however the amygdala and hippocampus were not resected because of bleeding and congestive edema in the lesion area. Refractory status resolved after surgery and she attained long term seizure freedom over 4 years [32] .…”

Section: Discussionmentioning

confidence: 96%

Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl

Marashly

Lew

Koop

2017

Epilepsy & Behavior Case Reports

View full text Add to dashboard Cite

Gelastic seizures (GS) are typically associated with hypothalamic hamartomas and present during childhood. However it is now known that GS can be found in focal epilepsies arising from other regions in the brain, including mesial and neocortical frontal, temporal and parietal regions.GS have rarely been described as the presenting manifestation of New Onset Refractory Status Epilepticus (NORSE). In this article we describe a previously healthy 3-year-old who presented with an explosive onset of GS that were refractory to multiple anti-seizure medications. These seizures arose from the right frontal region. An extensive metabolic and immunological evaluation was negative. Her brain magnetic resonance imaging (MRI) was negative, however the Positron Emission Tomography (PET) scan showed a hypermetabolic region in the right frontal inferior gyrus.She underwent a depth electrode evaluation that revealed a widespread irritative zone involving the PET “lesion” as well as mesial and neocortical regions in the right frontal lobe. The seizure onset zone was widespread and non-localizable. However the GS were associated with a clear ictal epileptiform discharge on invasive EEG arising from the depth of the superior frontal gyrus, which was not overlapping with the PET hypermetabolic region. She underwent a right frontal lobectomy sparing the primary motor region in the pre-central gyrus. She has remained seizure free for 15 months since. The pathological analysis showed focal cortical dysplasia type II in the region of the PET scan hypermetabolism. This case expands the clinical spectrum of GS to include cases of NORSE. Additionally the case highlights the role of resective surgery in GS presenting as NORSE and the potentially excellent outcome that can be achieved by early intervention.

show abstract

Section: Discussionmentioning

confidence: 96%

Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl

Marashly

Lew

Koop

2017

Epilepsy & Behavior Case Reports

View full text Add to dashboard Cite

show abstract

“…Hemispherectomy for the refractory status epileptics was first reported in 2004 where anatomic hemispherectomy was done on a 7-year boy with cortical dysplasia in RSE [16] . The first 2 adult cases of hemispherotomy for RSE was reported by Oderiz et al in 2015 [17] followed by two more adult cases reported by McGinity M et al in 2016 [11] . Until now, only four cases of hemispherotomy for RSE in adults have been reported [11] .…”

Section: Discussionmentioning

confidence: 99%

Hemispherotomy for late post-traumatic super-refractory status epilepticus in an adult

Nayak

Mathew

Rajgopal

et al. 2017

Epilepsy & Behavior Case Reports

View full text Add to dashboard Cite

“…Due to extensive spatial sampling with modern systems now including more than 300 specialized sensors distributed over the surface of the head, source localization accuracy with MEG can be high, reaching 2 to 3 mm , but this relationship is variably dependent on the size and pathology of the underlying epileptic lesion (Bast et al, 2004;Widjaja et al, 2008;Mu et al, 2014). A high level of data concordance between MEG and these studies, as well as with invasive investigatory techniques such as stereoelectroencephalography (SEEG) or electrocorticography (ECoG), is associated with more favorable surgical outcomes (Cuello-Oderiz et al, 2015;Murakami et al, 2016). MEG can be very helpful in localization of non-lesional, multi-lesional, and extratemporal epilepsies, which tend to be especially prevalent in children, as approximately 50% of surgical cases in children have an underlying etiology of dysplasia or brain malformation (Jung et al, 2013;Albert et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Indications for Inpatient Magnetoencephalography in Children – An Institution’s Experience

Watkins

Shah

Funke

et al. 2021

Front. Hum. Neurosci.

View full text Add to dashboard Cite

Magnetoencephalography (MEG) is recognized as a valuable non-invasive clinical method for localization of the epileptogenic zone and critical functional areas, as part of a pre-surgical evaluation for patients with pharmaco-resistant epilepsy. MEG is also useful in localizing functional areas as part of pre-surgical planning for tumor resection. MEG is usually performed in an outpatient setting, as one part of an evaluation that can include a variety of other testing modalities including 3-Tesla MRI and inpatient video-electroencephalography monitoring. In some clinical circumstances, however, completion of the MEG as an inpatient can provide crucial ictal or interictal localization data during an ongoing inpatient evaluation, in order to expedite medical or surgical planning. Despite well-established clinical indications for performing MEG in general, there are no current reports that discuss indications or considerations for completion of MEG on an inpatient basis. We conducted a retrospective institutional review of all pediatric MEGs performed between January 2012 and December 2020, and identified 34 cases where MEG was completed as an inpatient. We then reviewed all relevant medical records to determine clinical history, all associated diagnostic procedures, and subsequent treatment plans including epilepsy surgery and post-surgical outcomes. In doing so, we were able to identify five indications for completing the MEG on an inpatient basis: (1) super-refractory status epilepticus (SRSE), (2) intractable epilepsy with frequent electroclinical seizures, and/or frequent or repeated episodes of status epilepticus, (3) intractable epilepsy with infrequent epileptiform discharges on EEG or outpatient MEG, or other special circumstances necessitating inpatient monitoring for successful and safe MEG data acquisition, (4) MEG mapping of eloquent cortex or interictal spike localization in the setting of tumor resection or other urgent neurosurgical intervention, and (5) international or long-distance patients, where outpatient MEG is not possible or practical. MEG contributed to surgical decision-making in the majority of our cases (32 of 34). Our clinical experience suggests that MEG should be considered on an inpatient basis in certain clinical circumstances, where MEG data can provide essential information regarding the localization of epileptogenic activity or eloquent cortex, and be used to develop a treatment plan for surgical management of children with complicated or intractable epilepsy.

show abstract

Surgical treatment of focal symptomatic refractory status epilepticus with and without invasive EEG

Cited by 19 publications

References 7 publications

Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl

Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl

Hemispherotomy for late post-traumatic super-refractory status epilepticus in an adult

Indications for Inpatient Magnetoencephalography in Children – An Institution’s Experience

Contact Info

Product

Resources

About