scholarly journals Surgical Treatment of Epilepsy in Pediatric Patients

2000 ◽  
Vol 27 (2) ◽  
pp. 106-110 ◽  
Author(s):  
Elaine Wyllie
Keyword(s):  
Pediatric Patients ◽  
Focal Epilepsy ◽  
Hippocampal Sclerosis ◽  
Intractable Epilepsy ◽  
Postoperative Outcome ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Developmental Issues ◽  
Relative Risks

ABSTRACT:Surgery has become an accepted treatment modality for carefully selected adults with intractable focal epilepsy. More recently, increasing numbers of pediatric patients with intractable epilepsy are also being referred for surgical consideration. Key elements of surgical candidacy include medically intractable focal epilepsy, a localized epileptogenic zone, and a low risk for new postoperative neurologic deficits. The most common etiologies of the epilepsies in pediatric surgical candidates are malformation of cortical development and low grade tumor but some patients with childhood onset temporal lobe epilepsy due to hippocampal sclerosis also present for early surgery. Based on results from several recent pediatric surgical series, the chance for favorable seizure outcome after surgery is not adversely affected by young age, with seizure-free postoperative outcome reported for 60% to 65% of infants, 59% to 67% of children, and 69% of adolescents, compared to 64% reported in a large, predominantly adult series. Some subgroups of patients have higher percentages of seizure-free outcome, including those with hippocampal sclerosis or low grade tumor. In addition to seizures, developmental issues are also a major concern in children with intractable epilepsy. Few quantitative data are available, but some anecdotal experience suggests that surgical relief of catastrophic epilepsy may result in resumption of developmental progression after surgery, although the rate of development often remains abnormal. In one series, best developmental outcomes were seen in patients with earliest surgery and highest level of preoperative development. For each patient, the timing of surgery must be carefully considered, based on a full assessment of the relative risks and benefits, derived from a detailed presurgical evaluation.

Stereoelectroencephalography in Children and Adolescents With Difficult-to-Localize Refractory Focal Epilepsy

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 258-268 ◽  
Author(s):  
Jorge Gonzalez-Martinez ◽  
Jeffrey Mullin ◽  
Juan Bulacio ◽  
Ajay Gupta ◽  
Rei Enatsu ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Pediatric Patients ◽  
Focal Epilepsy ◽  
Early Experience ◽  
Morbidity Rate ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Eloquent Cortex

Abstract BACKGROUND: Although stereoelectroencephalography (SEEG) has been shown to be a valuable tool for preoperative decision making in focal epilepsy, there are few reports addressing the utility and safety of SEEG methodology applied to children and adolescents. OBJECTIVE: To present the results of our early experience using SEEG in pediatric patients with difficult-to-localize epilepsy who were not considered candidates for subdural grid evaluation. METHODS: Thirty children and adolescents with the diagnosis of medically refractory focal epilepsy (not considered ideal candidates for subdural grids and strip placement) underwent SEEG implantation. Demographics, electrophysiological localization of the hypothetical epileptogenic zone, complications, and seizure outcome after resections were analyzed. RESULTS: Eighteen patients (60%) underwent resections after SEEG implantations. In patients who did not undergo resections (12 patients), reasons included failure to localize the epileptogenic zone (4 patients); multifocal epileptogenic zone (4 patients); epileptogenic zone located in eloquent cortex, preventing resection (3 patients); and improvement in seizures after the implantation (1 patient). In patients who subsequently underwent resections, 10 patients (55.5%) were seizure free (Engel class I) and 5 patients (27.7%) experienced seizure improvement (Engel class II or III) at the end of the follow-up period (mean, 25.9 months; range, 12 to 47 months). The complication rate in SEEG implantations was 3%. CONCLUSION: The SEEG methodology is safe and should be considered in children/adolescents with difficult-to-localize epilepsy. When applied to highly complex and difficult-to-localize pediatric patients, SEEG may provide an additional opportunity for seizure freedom in association with a low morbidity rate.

Seizure-free and neuropsychological outcomes after temporal lobectomy with amygdalohippocampectomy in pediatric patients with hippocampal sclerosis

2012 ◽  
Vol 10 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Sumeet Vadera ◽  
Varun R. Kshettry ◽  
Patricia Klaas ◽  
William Bingaman
Keyword(s):  
Pediatric Patients ◽  
Hippocampal Sclerosis ◽  
Pediatric Population ◽  
Cleveland Clinic ◽  
Intractable Epilepsy ◽  
Cortical Dysplasia ◽  
Temporal Lobectomy ◽  
Low Grade ◽  
Neuropsychological Outcomes

Object Temporal lobe epilepsy is an uncommon clinical syndrome in the pediatric population. The most common underlying pathologies include low-grade gliomas, cortical dysplasia, and, less commonly, hippocampal sclerosis (HS). There is a paucity of data on neuropsychological and seizure-free outcomes in these patients after temporal lobectomy. In this study, the authors reviewed their seizure-free and neuropsychological outcomes after temporal lobectomy for pediatric HS. Methods The authors retrospectively reviewed the medical records of pediatric patients with HS who underwent anterior temporal lobectomy and amygdalohippocampectomy between 1998 and 2011 at the Cleveland Clinic. Results of neuropsychological assessment before and after surgery and seizure-free outcome at last follow-up were obtained. Results Forty-five patients met the inclusion criteria. Thirty-four (76%) patients had pathology of HS alone and 10 (22%) had HS and cortical dysplasia. The mean duration of follow-up was 60.2 months. Eighty-four percent of patients had postoperative Engel Class I or II outcomes. Neuropsychological outcomes remained unchanged or minimally improved postoperatively. Conclusions Seizure-free outcomes in pediatric HS are similar to historical rates in adult HS. Neuropsychological assessments remain stable after temporal lobectomy. Standard temporal lobectomy should be considered in pediatric patients with medically intractable epilepsy secondary to HS.

scholarly journals AS2-1 TREATMENT OF BENIGN INTRA-AXIAL BRAIN TUMORS IN CHILDREN ASSOCIATED WITH EPILEPSY

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii1-ii2
Author(s):  
Takeshi Matsuo
Keyword(s):  
Early Onset ◽  
Focal Epilepsy ◽  
Tumor Resection ◽  
Benign Tumors ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Term Survival ◽  
Daily Lives ◽  
Epithelial Tumors

Abstract Low grade neuro-epithelial tumors presenting early-onset epilepsy as the major neurological symptom have recently been categorized as low-grade epilepsy-associated neuro-epithelial tumors, LEAT. Ganglioglioma and dysembryoplastic neuroepithelial tumors consist up to 60% of LEAT. Common characteristics of LEAT being early onset seizure, younger than the age of 15, and temporal lobe localization, its criteria do not include histological or genetic features; LEAT is an independent classification, unrelated to WHO classification. Treatment for epilepsy associated with LEAT includes medication and surgery. As for drug therapy, most tumor-related seizures are controlled well with anti-epileptic drugs for focal epilepsy such as sodium channel blocker. On the other hand, those who are drug-resistant are candidates for surgical therapy. Because epileptogenic zone mostly exists not in tumor itself but in the marginal brain tissue, pure tumor resection without resection of peripheral epileptogenic zone sometimes fails to achieve satisfactory seizure outcome. Concept of epilepsy surgery is indispensable in pre-operative evaluation and in planning surgical strategy. Related association fibers in addition to five zones, epileptogenic zone, seizure onset zone, irritative zone, symptomatogenic zone and functional deficit zone should be taken into consideration. Long-term survival is expected in children who underwent total resection of benign tumors. Therefore, good seizure control is crucial in improving activities of daily lives.

scholarly journals The Impact of Lesional Factors on Seizure Outcome Following Lesionectomy as a Surgical Management of Extratemporal Epilepsy, Case Series from a Developing Country and Review of Literature.

2021 ◽  
Author(s):  
Amr Ali Hasanain ◽  
Mohamed Sawan ◽  
Ahmed Mohamed Ali
Keyword(s):  
Focal Epilepsy ◽  
Focal Lesion ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Seizure Semiology ◽  
Radiological Data ◽  
The Impact

Abstract BACKGROUNDExtratemporal lesional epilepsy can be managed with various surgical techniques such as simple lesionectomy or more extensive resections, all of which aim at targeting the epileptogenic zone which is the key for achieving a favorable outcome. This study aimed at evaluating the effectiveness of lesionectomy in the treatment of extra-temporal epilepsy associated with a lesion on radiological imaging, and to show the effect of lesional factors on seizure outcome including the anatomical location, the relation to cerebral parenchyma, the extent of surgical excision and the histopathological nature of the lesion.METHODSA prospective study on 20 patients presenting with focal epilepsy, or focal epilepsy with secondary generalized seizures with evidence of focal lesion in an extratemporal location on MRI. Lesionectomy was done and we used the Engel’s classification for seizure outcome.RESULTSLesions were mostly tumors (85 %). The frontal lobe is the most frequent locations (60 %). Low-grade glioma represented 35 % while meningioma represented 45 % of all lesions (both intra-axial and extra-axial). Four patients were lost during follow up (mean 23.31 months). For the remaining 16 patients, 13 cases were tumors (81.25%). Lesionectomy achieved seizure freedom in 68.75 %.CONCLUSIONSIn a country with limited resources, lesionectomy is a valid technique for epilepsy surgery as long as the radiological data and the seizure semiology are concordant. Total lesionectomy provides good seizure control when the clinical and radiological data are concordant with seizure semiology, in particular with tumor-related epilepsy. A study comparing postoperative seizure outcome between intra-axial and extra-axial lesions on a larger scale and with a longer follow up period is recommended.

Multiple hippocampal transections for refractory pediatric mesial temporal lobe epilepsy: seizure and neuropsychological outcomes

2020 ◽  
Vol 26 (4) ◽  
pp. 379-388
Author(s):  
Ahmad Marashly ◽  
Jennifer Koop ◽  
Michelle Loman ◽  
Irene Kim ◽  
Mohit Maheshwari ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Verbal Memory ◽  
Focal Epilepsy ◽  
Hippocampal Sclerosis ◽  
Neuropsychological Functioning ◽  
Memory Function ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Seizure Propagation

OBJECTIVETemporal lobe epilepsy (TLE) is the most common focal epilepsy across adult and pediatric age groups. It is also the most amenable to surgery, with excellent long-term seizure outcome. Most TLE cases have an epileptogenic zone in the mesial temporal structures, namely the hippocampus. Resecting the dominant hippocampus has been shown to be associated with significant verbal memory deficits, especially in patients with intact verbal memory scores presurgically. Multiple hippocampal transection (MHT) is a relatively new surgical technique designed to interrupt the longitudinal hippocampal circuitry involved in seizure propagation yet preserve the circular fibers involved in memory function. This technique has been used to treat mesial TLE in both dominant- and nondominant-hemisphere cases, almost exclusively in adults. It has been applied to normal and sclerotic hippocampi.METHODSIn this study, information on 3 pediatric patients who underwent MHT for mesial TLE at Children’s Wisconsin between 2017 and 2018 is included. Clinical, electroencephalographic, and neuropsychological features and outcomes are described in detail.RESULTSMRI revealed a tumor in the amygdala with a normal hippocampus in 1 patient and hippocampal sclerosis in 2 patients. All patients underwent stereoelectroencephalography confirming the involvement of the hippocampus in seizure onset. MHTs were completed under intraoperative monitoring, with amygdala and temporal tip resection in all patients due to early spread to these regions. All patients had excellent seizure outcomes at 1 year, and 2 of the 3 patients remain seizure free at last follow-up (range 20–36 months), all with stable or improved neuropsychological profiles, including verbal memory.CONCLUSIONSMHT is a relatively new surgical procedure designed to preserve essential memory circuitry while disrupting seizure propagation pathways in the hippocampus. A growing body of literature shows good seizure and neuropsychological results, but mainly in adults. This is the first series of MHTs used exclusively in children at one medical center, showcasing excellent seizure control and preservation of neuropsychological functioning. One of the patients is also the first described to have MHT in the setting of an amygdalar tumor abutting the hippocampus, further expanding the pathological setting in which MHT can be used effectively.

Seizure outcome of surgical treatment of focal epilepsy associated with low-grade tumors in children

2013 ◽  
Vol 11 (2) ◽  
pp. 214-223 ◽  
Author(s):  
Micol Babini ◽  
Marco Giulioni ◽  
Ercole Galassi ◽  
Gianluca Marucci ◽  
Matteo Martinoni ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Focal Epilepsy ◽  
Class I ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Group A ◽  
Children And Young Adults ◽  
Group B ◽  
Age Range

Object Low-grade tumor (LGT) is an increasingly recognized cause of focal epilepsies, particularly in children and young adults, and is frequently associated with cortical dysplasia. The optimal surgical treatment of epileptogenic LGTs in pediatric patients has not been fully established. Methods In the present study, the authors retrospectively reviewed 30 patients (age range 3–18 years) who underwent surgery for histopathologically confirmed LGTs, in which seizures were the only clinical manifestation. The patients were divided into 2 groups according to the type of surgical treatment: patients in Group A (20 cases) underwent only tumor removal (lesionectomy), whereas patients in Group B (11 cases) underwent removal of the tumor and the adjacent epileptogenic zone (tailored surgery). One of the patients, who underwent 2 operations, is included in both groups. Follow-up ranged from 1 to 17 years. Results Sixteen (80%) of 20 patients in Group A had an Engel Class I outcome. In this group, 3 of 4 patients who were in Engel Classes II and III had temporomesial lesions. All patients in Group B had temporomesial tumors and were seizure free (Engel Class I). In this series, in temporolateral and extratemporal tumor locations, lesionectomy yielded a good seizure outcome. In addition, a young age at seizure onset (in particular < 4 years) was associated with a poor seizure outcome. Conclusions Tailored resection in temporomesial LGTs was associated with excellent seizure outcome, indicating that an adequate presurgical evaluation including extensive neurophysiological evaluation (long-term videoelectroencephalography monitoring) to plan appropriate surgical strategy is advised.

scholarly journals Synaptic Reshaping and Neuronal Outcomes in the Temporal Lobe Epilepsy

2021 ◽  
Vol 22 (8) ◽  
pp. 3860
Author(s):  
Elisa Ren ◽  
Giulia Curia
Keyword(s):  
Animal Models ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Current Knowledge ◽  
Focal Epilepsy ◽  
Ex Vivo ◽  
Hippocampal Sclerosis ◽  
Control Group ◽  
Epileptogenic Zone ◽  
Epileptiform Discharges

Temporal lobe epilepsy (TLE) is one of the most common types of focal epilepsy, characterized by recurrent spontaneous seizures originating in the temporal lobe(s), with mesial TLE (mTLE) as the worst form of TLE, often associated with hippocampal sclerosis. Abnormal epileptiform discharges are the result, among others, of altered cell-to-cell communication in both chemical and electrical transmissions. Current knowledge about the neurobiology of TLE in human patients emerges from pathological studies of biopsy specimens isolated from the epileptogenic zone or, in a few more recent investigations, from living subjects using positron emission tomography (PET). To overcome limitations related to the use of human tissue, animal models are of great help as they allow the selection of homogeneous samples still presenting a more various scenario of the epileptic syndrome, the presence of a comparable control group, and the availability of a greater amount of tissue for in vitro/ex vivo investigations. This review provides an overview of the structural and functional alterations of synaptic connections in the brain of TLE/mTLE patients and animal models.

Accuracy and Safety of Customized Stereotactic Fixtures for Stereoelectroencephalography in Pediatric Patients

2020 ◽  
pp. 1-8
Author(s):  
Constantin Pistol ◽  
Andrei Daneasa ◽  
Jean Ciurea ◽  
Alin Rasina ◽  
Andrei Barborica ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Perioperative Complications ◽  
Intractable Epilepsy ◽  
Target Point ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Localization Error ◽  
Temporal Area ◽  
Lateral Entry ◽  
Stereotactic Implantation

Stereoelectroencephalography (SEEG) in children with intractable epilepsy presents particular challenges. Their thin and partially ossified cranium, specifically in the temporal area, is prone to fracture while attaching stereotactic systems to the head or stabilizing the head in robot’s field of action. Postponing SEEG in this special population of patients can have serious consequences, reducing their chances of becoming seizure-free and impacting their social and cognitive development. This study demonstrates the safety and accuracy offered by a frameless personalized 3D printed stereotactic implantation system for SEEG investigations in children under 4 years of age. SEEG was carried out in a 3-year-old patient with drug-resistant focal epilepsy, based on a right temporal-perisylvian epileptogenic zone hypothesis. Fifteen intracerebral electrodes were placed using a StarFix patient-customized stereotactic fixture. The median lateral entry point localization error of the electrodes was 0.90 mm, median lateral target point localization error was 1.86 mm, median target depth error was 0.83 mm, and median target point localization error was 1.96 mm. There were no perioperative complications. SEEG data led to a tailored right temporal-insular-opercular resection, with resulting seizure freedom (Engel IA). In conclusion, patient-customized stereotactic fixtures are a safe and accurate option for SEEG exploration in young children.

scholarly journals Value of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation in treating drug-resistant focal epilepsy

2019 ◽  
Vol 5 (3) ◽  
pp. 189-202
Author(s):  
Jianjun Bai ◽  
Wenjing Zhou ◽  
Haixiang Wang ◽  
Bingqing Zhang ◽  
Jiuluan Lin ◽  
...  
Keyword(s):  
Refractory Epilepsy ◽  
Focal Epilepsy ◽  
Intractable Epilepsy ◽  
Epileptogenic Zone ◽  
Presurgical Evaluation ◽  
The Past ◽  
Limited Efficacy ◽  
Radiofrequency Thermocoagulation ◽  
Temporary Treatment ◽  
Promising Treatment

Stereoelectroencephalography (SEEG) has been widely used in the presurgical evaluation of patients with medically intractable epilepsy. In the past, SEEG was commonly used as a method for mapping and localizing the epileptogenic zone (EZ). Since 2004, several studies have been conducted to examine the effectiveness of SEEG-guided radiofrequency thermocoagulation (RF-TC) in treating refractory epilepsy. However, the seizure-free and responder rates varied greatly across studies. We aimed to analyze the outcome of 56 patients who were treated with SEEG-guided RF-TC to evaluate the effectiveness of this treatment. SEEG-guided RF-TC can be considered as a treatment for refractory epilepsy. However, due to its limited efficacy, SEEG-guided RF-TC might be regarded as a temporary treatment performed under SEEG rather than a promising treatment for refractory epilepsy.

scholarly journals Lacosamide-Induced Dyskinesia in Children With Intractable Epilepsy

2020 ◽  
Vol 35 (10) ◽  
pp. 662-666
Author(s):  
Nadine Madani ◽  
Jennifer A. O’Malley ◽  
Brenda E. Porter ◽  
Fiona M. Baumer
Keyword(s):  
Upper Extremity ◽  
Pediatric Patients ◽  
Focal Epilepsy ◽  
Intractable Epilepsy ◽  
High Dose ◽  
Drug Induced ◽  
Potential Side Effect ◽  
Increased Risk ◽  
The Face ◽  
Dose Dependent

Lacosamide, an antiepileptic drug prescribed for children with refractory focal epilepsy, is generally well tolerated, with dose-dependent adverse effects. We describe 4 children who developed a movement disorder in conjunction with the initiation and/or uptitration of lacosamide. Three patients developed dyskinesias involving the face or upper extremity whereas the fourth had substantial worsening of chronic facial tics. The patients all had histories suggestive of opercular dysfunction: 3 had seizure semiologies including hypersalivation, facial and upper extremity clonus while the fourth underwent resection of polymicrogyria involving the opercula. Onset, severity, and resolution of dyskinesias correlated with lacosamide dosing. These cases suggest that pediatric patients with dysfunction of the opercular cortex are at increased risk for developing drug-induced dyskinesias on high-dose lacosamide therapy. Practitioners should be aware of this potential side effect and consider weaning lacosamide or video electroencephalography (EEG) for differential diagnosis, particularly in pediatric patients with underlying opercular dysfunction.

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