Multiple hippocampal transections: Post-operative Memory Outcomes and Seizure Control

OBJECTIVEResection of brain tumors may lead to new-onset seizures but may also reduce seizure rates in patients presenting with seizures. Seizures are seen at presentation in about 24% of patients with brain tumors. For lesional epilepsy in general, early resection is associated with improved seizure control. However, the literature is limited regarding the occurrence of new-onset postoperative seizures, or rates of seizure control in those presenting with seizures, following resections of extratemporal low-grade gliomas (LGGs) in children.METHODSData were collected retrospectively from 4 large tertiary centers for children (< 18 years of age) who underwent resection of a supratentorial extratemporal (STET) LGG. The patients were divided into 4 groups based on preoperative seizure history: no seizures, up to 2 seizures, more than 2 seizures, and uncontrolled or refractory epilepsy. The authors analyzed the postoperative occurrence of seizures and the need for antiepileptic drugs (AEDs) over time for the various subgroups.RESULTSThe study included 98 children. Thirty patients had no preoperative seizures, 18 had up to 2, 16 had more than 2, and 34 had refractory or uncontrolled epilepsy. The risk for future seizures was higher if the patient had seizures within 1 month of surgery. The risk for new-onset seizures among patients with no seizures prior to surgery was low. The rate of seizures decreased over time for children with uncontrolled or refractory seizures. The need for AEDs was higher in the more active preoperative seizure groups; however, it decreased with time.CONCLUSIONSThe resection of STET LGGs in children is associated with a low rate of postoperative new-onset epilepsy. For children with preoperative seizures, even with uncontrolled epilepsy, most have a significant improvement in the seizure activity, and many may be weaned off their AEDs.

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Sleep and epilepsy—chicken or egg?

10.1093/oso/9780198778240.003.0011 ◽

2018 ◽

Author(s):

Dora A. Lozsadi

Keyword(s):

Side Effects ◽

Sleep Disorders ◽

Learning Disability ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Seizure Control ◽

Subjective Sleep ◽

Neurological Conditions ◽

The Uk ◽

Patients With Epilepsy

Epilepsy is the commonest serious chronic neurological condition, affecting 0.5% of the population in the UK. Subjective sleep disturbance and excessive daytime sleepiness are reported to be 50% more frequent in those with epilepsy than in controls. Causes are multiple. Both poor seizure control and nocturnal attacks are known to contribute to such sleep disorders. Epilepsy also increases the risk of associated sleep disorders, and additional neurological conditions, such as dementia, learning disability, and depression. These all affect sleep hygiene. Prescribed anti-epileptic drugs will further aggravate the problem. Side-effects will include drowsiness. Sedating benzodiazepines and barbiturates are considered worst offenders. Others affect sleep architecture to varying degrees and/or cause insomnia. While hyper-somnolence in patients with epilepsy will raise the possibility of any of the above issues, sleep deprivation is one of the commonest seizure triggers. This chapter will shed more light on the intricate relationship between sleep and epilepsy.

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Reflex Epilepsy with Hot Water: Clinical and EEG Findings, Treatment, and Prognosis in Childhood

Neuropediatrics ◽

10.1055/s-0040-1709455 ◽

2020 ◽

Vol 51 (05) ◽

pp. 336-340 ◽

Cited By ~ 1

Author(s):

Fatma Hanci ◽

Sevim Türay ◽

Paşa Balci ◽

Nimet Kabakuş

Keyword(s):

Seizure Control ◽

Hot Water ◽

Reflex Epilepsy ◽

Therapeutic Approaches ◽

Water Age ◽

Epileptiform Discharges ◽

Neurology Clinic ◽

Neuromuscular Development ◽

The Brain ◽

International League

AbstractHot water epilepsy (HWE) is a subtype of reflex epilepsy in which seizures are triggered by the head being immersed in hot water. Hot water or bathing epilepsy is the type of reflex epilepsy most frequently encountered in our clinic. We describe our patients with HWE and also discuss the clinical features, therapeutic approaches, and prognosis. Eleven patients (10 boys, 1 girl), aged 12 months to 13 years, admitted to the pediatric neurology clinic between January 2018 and August 2019, and diagnosed with HWE or bathing epilepsy based on International League Against Epilepsy (ILAE)-2017, were followed up prospectively for ∼18 months. Patients' clinical and electroencephalography (EEG) findings and treatment details were noted. All 11 patients' seizures were triggered by hot water. Age at first seizure was between 2 months and 12 years. Seizure types were generalized motor seizures, absence, and atonic. EEG was normal in two patients, but nine patients had epileptiform discharges. Magnetic resonance imaging of the brain was performed and reported as normal (except in one case). Histories of prematurity were present in two patients, unprovoked seizures in one, and low birth weight and depressed birth in the other. Patients with HWE have normal neuromuscular development and neurological examination results, together with prophylaxis or seizure control with a single antiepileptic drug, suggesting that it is a self-limited reflex epilepsy.

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Patient, caregiver, and healthcare professional perspectives on seizure control and treatment goals

Epilepsy & Behavior ◽

10.1016/j.yebeh.2021.107816 ◽

2021 ◽

Vol 117 ◽

pp. 107816

Author(s):

Danielle A. Becker ◽

Lucretia Long ◽

Nancy Santilli ◽

Jane Babrowicz ◽

Eugenia Y. Peck

Keyword(s):

Healthcare Professional ◽

Seizure Control ◽

Treatment Goals ◽

Professional Perspectives

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Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care

Journal of the Intensive Care Society ◽

10.1177/17511437211025410 ◽

2021 ◽

pp. 175114372110254

Author(s):

Evangelia Poimenidi ◽

Yavor Metodiev ◽

Natasha Nicole Archer ◽

Richard Jackson ◽

Mansoor Nawaz Bangash ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critical Care ◽

Liver Failure ◽

Hellp Syndrome ◽

Seizure Control ◽

Liver Enzymes ◽

Kidney Injury ◽

Definitive Treatment ◽

Multisystem Disease ◽

Elevated Liver Enzymes

A thirty-year-old pregnant woman was admitted to hospital with headache and gastrointestinal discomfort. She developed peripheral oedema and had an emergency caesarean section following an episode of tonic-clonic seizures. Her delivery was further complicated by postpartum haemorrhage and she was admitted to the Intensive Care Unit (ICU) for further resuscitation and seizure control which required infusions of magnesium and multiple anticonvulsants. Despite haemodynamic optimisation she developed an acute kidney injury with evidence of liver damage, thrombocytopenia and haemolysis. Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome, a multisystem disease of advanced pregnancy which overlaps with pre-eclampsia, was diagnosed. HELLP syndrome is associated with a range of complications which may require critical care support, including placental abruption and foetal loss, acute kidney injury, microangiopathic haemolytic anaemia, acute liver failure and liver capsule rupture. Definitive treatment of HELLP is delivery of the fetus and in its most severe forms requires admission to the ICU for multiorgan support. Therapeutic strategies in ICU are mainly supportive and include blood pressure control, meticulous fluid balance and possibly escalation to renal replacement therapy, mechanical ventilation, neuroprotection, seizure control, and management of liver failure-related complications. Multidisciplinary input is essential for optimal treatment.

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Neuropsychological performance and seizure control after subsequent anteromesial temporal lobe resection following selective amygdalohippocampectomy

Epilepsia ◽

10.1111/epi.13567 ◽

2016 ◽

Vol 57 (11) ◽

pp. 1789-1797 ◽

Cited By ~ 3

Author(s):

Thomas Sauvigny ◽

Katja Brückner ◽

Lasse Dührsen ◽

Oliver Heese ◽

Manfred Westphal ◽

...

Keyword(s):

Temporal Lobe ◽

Seizure Control ◽

Neuropsychological Performance ◽

Selective Amygdalohippocampectomy ◽

Temporal Lobe Resection

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The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.10.peds14282 ◽

2015 ◽

Vol 15 (6) ◽

pp. 644-650 ◽

Cited By ~ 30

Author(s):

Chima O. Oluigbo ◽

Jichuan Wang ◽

Matthew T. Whitehead ◽

Suresh Magge ◽

John S. Myseros ◽

...

Keyword(s):

Epilepsy Surgery ◽

Seizure Control ◽

Brain Mri ◽

Age At Onset ◽

Cortical Dysplasia ◽

Complete Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Lesion Volume ◽

Resection Volume

OBJECT Focal cortical dysplasia (FCD) is one of the most common causes of intractable epilepsy leading to surgery in children. The predictors of seizure freedom after surgical management for FCD are still unclear. The objective of this study was to perform a volumetric analysis of factors shown on the preresection and postresection brain MRI scans of patients who had undergone resective epilepsy surgery for cortical dysplasia and to determine the influence of these factors on seizure outcome. METHODS The authors reviewed the medical records and brain images of 43 consecutive patients with focal MRI-documented abnormalities and a pathological diagnosis of FCD who had undergone surgical treatment for refractory epilepsy. Preoperative lesion volume and postoperative resection volume were calculated by manual segmentation using OsiriX PRO software. RESULTS Forty-three patients underwent first-time surgery for resection of an FCD. The age range of these patients at the time of surgery ranged from 2 months to 21.8 years (mean age 7.3 years). The median duration of follow-up was 20 months. The mean age at onset was 31.6 months (range 1 day to 168 months). Complete resection of the area of an FCD, as adjudged from the postoperative brain MR images, was significantly associated with seizure control (p = 0.0005). The odds of having good seizure control among those who underwent complete resection were about 6 times higher than those among the patients who did not undergo complete resection. Seizure control was not significantly associated with lesion volume (p = 0.46) or perilesion resection volume (p = 0.86). CONCLUSIONS The completeness of FCD resection in children is a significant predictor of seizure freedom. Neither lesion volume nor the further resection of perilesional tissue is predictive of seizure freedom.

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