Impact of epilepsy duration, seizure control and EEG abnormalities on cognitive impairment in drug-resistant epilepsy patients

2019 ◽  
Vol 119 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Aleksandar Gavrilovic ◽  
Gordana Toncev ◽  
Tatjana Boskovic Matic ◽  
Katarina Vesic ◽  
Jelena Ilic Zivojinovic ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Seizure Control ◽  
Drug Resistant ◽  
Eeg Abnormalities ◽  
Drug Resistant Epilepsy

scholarly journals Case Report: Hemispherotomy in the First Days of Life to Treat Drug-Resistant Lesional Epilepsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Konstantin L. Makridis ◽  
Christine Prager ◽  
Anna Tietze ◽  
Deniz A. Atalay ◽  
Sebastian Triller ◽  
...  
Keyword(s):  
Perioperative Management ◽  
Seizure Control ◽  
Neurological Deficits ◽  
Safe Procedure ◽  
Drug Resistant ◽  
Young Infants ◽  
Specialized Center ◽  
Surgical Conditions ◽  
Drug Resistant Epilepsy ◽  
Early Surgical Intervention

Background: Neonatal drug-resistant epilepsy is often caused by perinatal epileptogenic insults such as stroke, ischemia, hemorrhage, and/or genetic defects. Rapid seizure control is particularly important for cognitive development. Since early surgical intervention and thus a short duration of epilepsy should lead to an optimal developmental outcome, we present our experience with hemispherotomy in an infant at the corrected age of 1 week.Methods: We report successful hemispherotomy for drug-resistant epilepsy in an infant with hemimegalencephaly at a corrected age of 1 week.Results: The infant was diagnosed with drug-resistant lesional epilepsy due to hemimegalencephaly affecting the left hemisphere. Given congruent electroclinical findings, we performed a left vertical parasagittal transventricular hemispherotomy after critical interdisciplinary discussion. No complications occurred during the surgery. Intraoperatively; 118 ml of red blood cells (30 ml/kg) and 80 ml of plasma were transfused. The patient has been seizure-free since discharge without further neurological deficits.Conclusion: We demonstrate that early epilepsy surgery is a safe procedure in very young infants if performed in a specialized center experienced with age-specific surgical conditions and perioperative management. The specific surgical difficulties should be weighed against the risk of life-long developmental drawbacks of ongoing detrimental epilepsy.

scholarly journals Deep brain stimulation for seizure control in drug-resistant epilepsy

2018 ◽  
Vol 45 (2) ◽  
pp. E4 ◽  
Author(s):  
Neil Klinger ◽  
Sandeep Mittal
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Seizure Control ◽  
Effective Means ◽  
Drug Resistant ◽  
Thalamic Nuclei ◽  
Stimulation Parameters ◽  
Number Of Patients ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

Antiepileptic drugs prevent morbidity and death in a large number of patients suffering from epilepsy. However, it is estimated that approximately 30% of epileptic patients will not have adequate seizure control with medication alone. Resection of epileptogenic cortex may be indicated in medically refractory cases with a discrete seizure focus in noneloquent cortex. For patients in whom resection is not an option, deep brain stimulation (DBS) may be an effective means of seizure control. Deep brain stimulation targets for treating seizures primarily include the thalamic nuclei, hippocampus, subthalamic nucleus, and cerebellum. A variety of stimulation parameters have been studied, and more recent advances in electrical stimulation to treat epilepsy include responsive neurostimulation. Data suggest that DBS is effective for treating drug-resistant epilepsy.

scholarly journals Surgical treatment of drug-resistant epilepsy caused by gliomas in eloquent areas: experience report

2019 ◽  
Vol 77 (11) ◽  
pp. 797-805
Author(s):  
Gustavo Rassier Isolan ◽  
Vilson Marth ◽  
Leonardo Frizon ◽  
Leandro Dini ◽  
Símone Dini ◽  
...  
Keyword(s):  
Seizure Control ◽  
Univariate Analysis ◽  
Extent Of Resection ◽  
Seizure Outcome ◽  
Low Grade ◽  
Microsurgical Anatomy ◽  
Drug Resistant ◽  
Eloquent Areas ◽  
Eloquent Area ◽  
Drug Resistant Epilepsy

ABSTRACT Drug-resistant epilepsy associated with central nervous system tumors is generally caused by low grade gliomas. This group of tumors is usually found in brain eloquent areas, such as the insular lobe, rolandic cortex and supplementary motor area and, historically, possess a greater risk of postoperative deficits. Objective: The aim of this investigation was to present our surgical experience on patients with drug-resistant epilepsy caused by gliomas in eloquent areas. We retrospectively investigated variables that impact seizure control, such as tumor location, extent of resection, invasion into the lenticulostriate arteries in the patient, especially those with insular gliomas. Methods: Out of 67 patients with eloquent area brain tumors operated on in our service between 2007 and 2016, 14 patients had symptoms of drug-resistant epilepsy. Volumetric analysis, extent of resection (EOR), type of approach and mapping, among other factors were correlated with the 12-month postoperative seizure outcome. Results: Univariate analysis showed that the factors showing statistical relevance with seizure control were preoperative volume (p = 0.005), EOR (p = 0.028) and postoperative volume (p = 0.030). Conclusion: There was a statistically significant association between the EOR and the Engel score for epilepsy control: an EOR < 70 was associated with Engel II, III, IV and an EOR > 90 was associated with Engel I. Eloquent area gliomas can safely be resected when surgeons use not only microsurgical anatomy concepts but also brain mapping.

scholarly journals Unanticipated improvement in seizure control in drug-resistant epilepsy- real world observations

Seizure ◽  
2021 ◽  
Vol 84 ◽  
pp. 60-65
Author(s):  
Patrick B. Moloney ◽  
Daniel J. Costello
Keyword(s):  
Real World ◽  
Seizure Control ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy

scholarly journals Drug-resistant epilepsy, early-onset hypertension and white matter lesions: a hidden paraganglioma

2019 ◽  
Vol 12 (6) ◽  
pp. e228348
Author(s):  
Katri Silvennoinen ◽  
Alison J Waghorn ◽  
Simona Balestrini ◽  
Sanjay M Sisodiya
Keyword(s):  
White Matter ◽  
Seizure Control ◽  
Focal Epilepsy ◽  
White Matter Lesions ◽  
Drug Resistant ◽  
Deep Brain Stimulator ◽  
Drug Resistant Epilepsy ◽  
Hyperintense White Matter ◽  
Deep Brain

We describe the case of a 35-year-old man with focal epilepsy since age 16. Due to a refractory course, several treatments were tried over the years, including insertion of a deep brain stimulator. At the time of his first assessment at our unit, he had recently been diagnosed with hypertension. An MR scan of brain revealed multiple T2 hyperintense white matter lesions, and evidence of previous haemorrhage in the left basal ganglia and pons. On follow-up imaging, the changes were considered to be in keeping with hypertensive arteriopathy. He was referred for further assessment of his hypertension and was found to have a para-aortic paraganglioma. This was excised 16 months after his initial presentation to us. The surgery was associated with an improvement in his seizure control. This case serves as a reminder of the need to be vigilant about the possibility of coexisting conditions in people with epilepsy.

scholarly journals Medicinal Marijuana for Epilepsy: A Case Series Study

2014 ◽  
Vol 41 (6) ◽  
pp. 753-758 ◽  
Author(s):  
Lady Diana Ladino ◽  
Lizbeth Hernández-Ronquillo ◽  
José Francisco Téllez-Zenteno
Keyword(s):  
Psychiatric Comorbidity ◽  
Seizure Control ◽  
Previous History ◽  
Case Series ◽  
Tobacco Consumption ◽  
Drug Resistant ◽  
Concurrent Use ◽  
Case Series Study ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

AbstractObjective:To describe the social, clinical and use-patterns characteristics of medicinal marijuana use among patients with epilepsy (PWEs).Methods:Eighteen PWEs with prescriptions for medicinal marijuana from a Canadian adult-epilepsy clinic were included in this study.Results:Eighteen patients had a prescription of medicinal marijuana from a total population of 800 PWEs in our center (2.2%). Mean age of patients was 30±7.4 (19-50) years. Twelve (67%) patients were males. Eleven (61%) patients had drug-resistant epilepsy. Eleven (61%) patients suffered a psychiatric comorbidity and reported the use of illicit substances or heavy alcohol or tobacco consumption. Only two (11%) patients were married; the rest of patients (89%) were single or divorced. The drug use pattern was similar among patients. All patients asked for marijuana permission in the epilepsy clinic. Most (83%) had a previous history of marijuana smoking, with a mean of 6.6±3 (1-15) years. The mean consumption dose was 2.05±1.8 (0.5-8) grams per day. Ten (56%) patients reported withdrawal seizure exacerbation when they stopped the marijuana. Only two patients (11%) reported side effects, and all patients found medicinal marijuana very helpful for seizure control and improvement of mood disorder.Conclusions:PWEs using medicinal marijuana have a common profile. They are usually young single men with drug-resistant epilepsy and psychiatric comorbidity. Most used marijuana before formal prescription and all believe the drug was effective on their seizure control. Because of the concurrent use of other antiseizure medications, it is complex to estimate the actual effect of marijuana.

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