Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients

Abstract Introduction Vagal nerve stimulators (VNS) are a nonpharmacological treatment for patients with refractory epilepsy. The VNS can decrease seizure frequency by over 75% in 40% of pediatric patients with refractory epilepsy. An underrecognized side effect is sleep disordered breathing (SDB). The purpose of this study was to demonstrate how a sensor placed adjacent to the VNS lead can distinguish whether SDB is due to VNS discharge. Methods Five pediatric patients (ages: 5–8) with refractory epilepsy with VNS were referred to our sleep center for concern for SDB. Each patient underwent a polysomnogram (PSG) that included a standard PSG montage with a surface electrode placed adjacent to their left lateral neck to detect VNS discharge. VNS associated apnea hypopnea index (vAHI) was calculated by determining the number of hypopneas and obstructive apneas occurring during VNS discharge. Results Of the 5 patients, three met pediatric criteria for obstructive sleep apnea (OSA). Patient 1 had an obstructive AHI (oAHI) of 21.3 events/hr with a vAHI accounting for 79% of the total (16.8 events/hr), patient 2 had an oAHI of 16.6 events/hr with a vAHI accounting for 57% of the total (9.5 events/hr), and patient 3 had an oAHI of 1.9 events/hr with vAHI accounting for 68% of the total (1.3 events/hr). Because of these findings, the VNS settings of all 3 patients were changed with the goal of reducing SDB due to VNS discharge. Upon repeat PSG, patient 2 had reduced OSA with an oAHI of 3 events/hr, with no events associated with VNS discharge. The remaining 2 patients did not exhibit VNS associated SDB, however, both experienced increased respiratory rate during VNS discharge. Conclusion We demonstrated that a surface electrode adjacent to the VNS is able to temporally co-register VNS discharges and enabled us to directly correlate SDB to VNS stimulation in 3 patients with refractory epilepsy. Because of our findings, we titrated the VNS parameters in all 3 patients, with one showing resolution of VNS associated SDB on repeat PSG. We propose that an added surface electrode to detect VNS discharge be considered as standard practice in PSG studies of patients with VNS. Support (if any):

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Frameless robot-assisted stereoelectroencephalography for refractory epilepsy in pediatric patients: accuracy, usefulness, and technical issues

Acta Neurochirurgica ◽

10.1007/s00701-018-3720-8 ◽

2018 ◽

Vol 160 (12) ◽

pp. 2489-2500 ◽

Cited By ~ 5

Author(s):

Santiago Candela-Cantó ◽

Javier Aparicio ◽

Jordi Muchart López ◽

Pilar Baños-Carrasco ◽

Alia Ramírez-Camacho ◽

...

Keyword(s):

Pediatric Patients ◽

Refractory Epilepsy ◽

Robot Assisted ◽

Technical Issues

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Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients

Neurosurgical FOCUS ◽

10.3171/2018.6.focus18228 ◽

2018 ◽

Vol 45 (3) ◽

pp. E9 ◽

Cited By ~ 13

Author(s):

Zulma Tovar-Spinoza ◽

Robert Ziechmann ◽

Stephanie Zyck

Keyword(s):

Laser Ablation ◽

Minimally Invasive ◽

Pediatric Patients ◽

Refractory Epilepsy ◽

Neuropsychiatric Symptoms ◽

Thermal Therapy ◽

Seizure Outcome ◽

Laser Interstitial Thermal Therapy ◽

Cortical Tubers ◽

The Mean

OBJECTIVEMagnetic resonance–guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment for the surgical treatment of epilepsy. In this paper, the authors report on clinical outcomes for a series of pediatric patients with tuberous sclerosis complex (TSC) and medication-refractory epileptogenic cortical tubers.METHODSA retrospective chart review was performed at SUNY Upstate Golisano Children’s Hospital in Syracuse, New York. The authors included all cases involving pediatric patients (< 18 years) who underwent MRgLITT for ablation of epileptogenic cortical tubers between February 2013 and November 2015.RESULTSSeven patients with cortical tubers were treated (4 female and 3 male). The patients’ average age was 6.6 years (range 2–17 years). Two patients had a single procedure, and 5 patients had staged procedures. The mean time between procedures in the staged cases was 6 months. All of the patients had a meaningful reduction in seizure frequency as reported by Engel and ILAE seizure outcome classifications, and most (71.4%) of the patients experienced a reduction in AED burden. Three of the 4 patients who presented with neuropsychiatric symptoms had some improvement in these domains after laser ablation. No perioperative complications were noted. The mean duration of follow-up was 19.3 months (range 4–49 months).CONCLUSIONSLaser ablation represents a minimally invasive alternative to resective epilepsy surgery and is an effective treatment for refractory epilepsy due to cortical tubers.

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Seizure Surgery

10.1093/med/9780190685157.003.0027 ◽

2018 ◽

Author(s):

Caroll N. Vazquez-Colon ◽

Srijaya K. Reddy

Keyword(s):

Pediatric Patients ◽

Perioperative Management ◽

Seizure Control ◽

Refractory Epilepsy ◽

Intraoperative Neuromonitoring ◽

Anesthetic Agents ◽

Anesthetic Drugs ◽

Seizure Surgery ◽

Antiepileptic Medications

Epilepsy is a disorder of the nervous system that affects over 2 million people worldwide, with the highest incidence in children. Surgical management of a child with refractory epilepsy may result in improved seizure control and better quality of life. The perioperative management of the pediatric patient for seizure surgery presents a considerable challenge to the anesthesiologist. Primary concerns include the interactions of antiepileptic medications with anesthetic drugs, the effects of anesthetic agents and medications on intraoperative neuromonitoring, and management of seizures while under anesthesia. This chapter will focus on anesthetic concerns and management for pediatric patients presenting for seizure surgery.

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Compliance of pediatric patients with refractory epilepsy to ketogenic/Modified Atkins diet

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2016.03.056 ◽

2016 ◽

Vol 13 ◽

pp. e68

Author(s):

Sofia Zouganeli ◽

Euaggelia Tasiou ◽

Melpomeni Giorgi ◽

Maria Tsirouda ◽

Artemis Stefanede ◽

...

Keyword(s):

Pediatric Patients ◽

Refractory Epilepsy ◽

Modified Atkins Diet ◽

Atkins Diet

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Vagus nerve stimulation therapy in pediatric patients with refractory epilepsy: scientific basis and recommendations for use

Clinical Neurophysiology ◽

10.1016/s1388-2457(08)60514-3 ◽

2008 ◽

Vol 119 ◽

pp. S143

Author(s):

S. Helmers

Keyword(s):

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Pediatric Patients ◽

Refractory Epilepsy ◽

Scientific Basis

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Retrospective analysis of open surgical versus laser interstitial thermal therapy callosotomy in pediatric patients with refractory epilepsy

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.7.peds20167 ◽

2021 ◽

pp. 1-9

Author(s):

James P. Caruso ◽

M. Burhan Janjua ◽

Alison Dolce ◽

Angela V. Price

Keyword(s):

Blood Loss ◽

Retrospective Analysis ◽

Pediatric Patients ◽

Refractory Epilepsy ◽

Thermal Therapy ◽

Efficacy And Safety ◽

Corpus Callosotomy ◽

Laser Interstitial Thermal Therapy ◽

Medically Refractory Epilepsy

OBJECTIVECorpus callosotomy remains an established surgical treatment for certain types of medically refractory epilepsy in pediatric patients. While the traditional surgical approach is often well tolerated, the advent of MR-guided laser interstitial thermal therapy (LITT) provides a new opportunity to ablate the callosal body in a minimally invasive fashion and minimize the risks associated with an open interhemispheric approach. However, the literature is sparse regarding the comparative efficacy and safety profiles of open corpus callosotomy (OCC) and LITT callosotomy. To this end, the authors present a novel retrospective analysis comparing the efficacy and safety of these methods.METHODSPatients who underwent OCC and LITT callosotomy during the period from 2005 to 2018 were included in a single-center retrospective analysis. Patient demographic and procedural variables were collected, including length of stay, procedural blood loss, corticosteroid requirements, postsurgical complications, and postoperative disposition. Pre- and postoperative seizure frequency (according to seizure type) were recorded.RESULTSIn total, 19 patients, who underwent 24 interventions (16 OCC and 8 LITT), were included in the analysis. The mean follow-up durations for the OCC and LITT cohorts were 83.5 months and 12.3 months, respectively. Both groups experienced reduced frequencies of seizure and drop attack frequency postoperatively. Additionally, LITT callosotomy was associated with a significant decrease in estimated blood loss and decreased length of pediatric ICU stay, with a trend of shorter length of hospitalization.CONCLUSIONSLonger-term follow-up and a larger population are required to further delineate the comparative efficacies of LITT callosotomy and OCC for the treatment of pediatric medically refractory epilepsy. However, the authors’ data demonstrate that LITT shows promise as a safe and effective alternative to OCC.

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Navigated transcranial magnetic stimulation mapping of the motor cortex for preoperative diagnostics in pediatric epilepsy

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.2.peds20901 ◽

2021 ◽

pp. 1-8

Author(s):

Severin Schramm ◽

Aashna Mehta ◽

Kurtis I. Auguste ◽

Phiroz E. Tarapore

Keyword(s):

Transcranial Magnetic Stimulation ◽

Motor Cortex ◽

Magnetic Stimulation ◽

Pediatric Patients ◽

Refractory Epilepsy ◽

Pediatric Epilepsy ◽

Epilepsy Patient ◽

Navigated Transcranial Magnetic Stimulation ◽

Motor Mapping ◽

Medically Refractory Epilepsy

OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) is a noninvasive technique often used for localization of the functional motor cortex via induction of motor evoked potentials (MEPs) in neurosurgical patients. There has, however, been no published record of its application in pediatric epilepsy surgery. In this study, the authors aimed to investigate the feasibility of nTMS-based motor mapping in the preoperative diagnostic workup within a population of children with medically refractory epilepsy. METHODS A single-institution database was screened for preoperative nTMS motor mappings obtained in pediatric patients (aged 0 to 18 years, 2012 to present) with medically refractory epilepsy. Patient clinical data, demographic information, and mapping results were extracted and used in statistical analyses. RESULTS Sixteen patients met the inclusion criteria, 15 of whom underwent resection. The median age was 9 years (range 0–17 years). No adverse effects were recorded during mapping. Specifically, no epileptic seizures were provoked via nTMS. Recordings of valid MEPs induced by nTMS were obtained in 10 patients. In the remaining patients, no MEPs could be elicited. Failure to generate MEPs was associated significantly with younger patient age (r = 0.8020, p = 0.0001863). The most frequent seizure control outcome was Engel Epilepsy Surgery Outcome Scale class I (9 patients). CONCLUSIONS Navigated TMS is a feasible, effective, and well-tolerated method for mapping the motor cortex of the upper and lower extremities in pediatric patients with epilepsy. Patient age modulates elicitability of MEPs, potentially reflecting various stages of myelination. Successful motor mapping has the potential to add to the existing presurgical diagnostic workup in this population, and further research is warranted.

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