The effect of surgery in encephalopathy with electrical status epilepticus during sleep

Abstract

Summary Purpose: We analyzed clinical and electroencephalography (EEG) outcomes of 13 patients with pharmacoresistant encephalopathy with electrical status epilepticus during sleep (ESES) following epilepsy surgery. Methods: All patients had symptomatic etiology of ESES and preoperative neuropsychological deterioration. Ten patients had daily atypical absences. Clinical outcome was assessed at 6 months and at 2 years after surgery. Clinical and EEG data were reviewed retrospectively. The spike propagation pattern and area and source strength in source montage were analyzed from preoperative and postoperative EEG studies. Key Findings: Preoperative sleep EEG showed electrical status epilepticus during sleep (SES) with one‐way interhemispheric propagation in nine patients and with two‐way interhemispheric propagation in four. The age of the patients at the time of surgery ranged from 3.6–9.9 years. Focal resection (two patients) or hemispherotomy (one patient with postoperative EEG) either terminated SES or restricted the discharge to one region. Either reduced SES propagation area or source strength was found in four of eight callosotomy patients with postoperative EEG. Of patients who had seizures preoperatively, Engel class I–II seizure outcome was observed in two of three children after focal resection or hemispherotomy and in two of eight children after callosotomy. None of these patients with Engel class I–II outcome had SES with two‐way interhemispheric propagation on preoperative EEG. Cognitive deterioration was halted postoperatively in all except one patient. Cognitive catch‐up of more than 10 IQ points was seen in three patients, all of whom had shown a first measured IQ of >75. Significance: Patients with pharmacoresistant ESES based on symptomatic etiology may benefit from resective surgery or corpus callosotomy regarding both seizure outcome and cognitive prognosis.

Sleep-potentiated epileptiform activity in early thalamic injuries: Study in a large series (60 cases)

“…Concerning the onset of paroxysmal activity in sleep, literature data, usually in retrospective studies, are controversial, going from a median of 3.9 (Peltola et al, 2011) to 8 (Caraballo et al, 2008) possibly due to the heterogeneity of selected cases and to the difficulty to perform well-timed EEG study in detecting the ESES pattern during sleep. The mean age at SPEA onset in our symptomatic series was generally at about the fifth year with a limited standard deviation.…”

Continuous Spikes and Waves during Sleep: Electroclinical Presentation and Suggestions for Management

“…The terms “ESES,” “CSWS,” and “Landau-Kleffner syndrome” have been used interchangeably in the literature to refer to the EEG pattern of frequent spike-waves or to the associated epileptic encephalopathy with regression [6–8]. The EEG pattern and the associated epileptic encephalopathy are different concepts that might require differentiated names.…”

Temporal Lobe Epilepsy in Children

“…These include Landau Kleffner syndrome (LKS), continuous spike-wave during slow-wave sleep syndrome (CSWS), and benign childhood epilepsy with centrotemporal spikes (BCECTSs). Although epilepsy syndromes such as LKS and CSWS have been proven to be secondary to focal pathology amenable to resection in select children [51, 52], this infrequently localizes to the temporal lobe. …”