scholarly journals SREAT presenting as decades of intractable seizures and isolated delusional episodes with clinical, laboratory, and EEG confirmation of treatment response

2019 ◽  
Vol 7 ◽  
pp. 2050313X1985005
Author(s):  
Elysia Tjong ◽  
Rachael Gardner ◽  
Yen-Yi Peng
Keyword(s):  
Epilepsy Surgery ◽  
Autoimmune Thyroiditis ◽  
Clinical Laboratory ◽  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Intractable Seizures ◽  
Autoimmune Epilepsy ◽  
History Of ◽  
Quantitative Electroencephalogram

We report a case of a 60-year-old woman with a history of intractable seizures and isolated delusional psychosis who was later diagnosed with steroid-responsive encephalopathy associated with autoimmune thyroiditis. The patient underwent right temporal lobectomy (epilepsy surgery) 15 years before coming to this clinic, but continued to have focal seizures, resulting in frequent emergency room visits thereafter. After admission for intensive inpatient video electroencephalogram monitoring and subsequent 7 months of close follow-up, both the electroencephalogram abnormalities and isolated delusional psychosis were found to be responsive to immunotherapy. This suggests that her epilepsy may be autoimmune in nature. Steroid-responsive encephalopathy associated with autoimmune thyroiditis was diagnosed after 26 years since the onset of seizures. Performing invasive epilepsy surgery in patients with autoimmune epilepsy cannot reverse the inflammatory process; therefore, it is reasonable to test for autoimmune etiologies before excision surgery on patients with medically intractable epilepsy. This case demonstrates the clinical use of quantitative electroencephalogram in assisting with the diagnosis of steroid-responsive encephalopathy associated with autoimmune thyroiditis and supports that it is a spectrum disorder with protean manifestations.

scholarly journals Rasmussen Encephalitis: longterm outcome after surgery

2010 ◽  
Vol 16 (2) ◽  
pp. 59-63 ◽  
Author(s):  
Vera C. Terra ◽  
Helio R. Machado ◽  
Ricardo dos Santos Oliveira ◽  
Luciano N Serafini ◽  
Cecília Souza-Oliveira ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Language Impairment ◽  
Seizure Control ◽  
Demographic Data ◽  
Intractable Epilepsy ◽  
Seizure Outcome ◽  
Rasmussen Encephalitis ◽  
Eeg Abnormalities ◽  
Clonic Seizures

BACKGROUND AND PURPOSE: Rasmussen Encephalitis (RE) is characterized by intractable epilepsy, progressive hemiparesis and unilateral hemispheric atrophy. The progression of the symptoms usually occurs within months to few years. Antiepileptic drugs are usually not effective to control disease progression and epilepsy surgery in the form of hemispheric disconnection has been considered the treatment of choice. This work describes the clinical and electrographic analyses, as well as the post-operative evolution of patients with RE. PATIENTS AND METHODS: This work includes all the patients with RE evaluated from January 1995 to January 2008 by the Ribeirão Preto Epilepsy Surgery Program (CIREP) considering demographic data, interictal and ictal electroencephalographic (EEG) findings; anatomo-pathological findings and clinical outcome. RESULTS: Twenty-five patients were evaluated, thirteen were female. Mean age of epilepsy onset was 4.4±2.0 years. There were no differences between patients with slow and fast evolution with respect to age of epilepsy onset (p=0.79), age at surgery (p=0.24), duration of epilepsy (0.06), and follow-up (p=0.40). There were no correlations between the presence of bilateral EEG abnormalities or the absence of spikes and post-operative seizure outcome (p=0.06). Twenty-three patients underwent surgery. The mean follow-up was 75.3 months. Eleven patients had total seizure control. Twelve individuals persisted with seizures consisting of mild facial jerks (6 patients), occasional hemigeneralized tonic-clonic seizures (3 patients), and frequent tonic-clonic seizures (3 patients). Mental and language impairment was observed in 15 and 12 patients, after surgery, respectively. CONCLUSIONS: This retrospective study reported the clinical and electrographic analysis, as well as the evolution of 23 patients with RE. Fourteen patients achieved satisfactory seizure control, three patients had partial response to surgery, and five patients had maintenance of the pre-operative condition. All patients with left side involvement presented with some language and cognitive disturbance.

scholarly journals Patient-assessed satisfaction and outcome after microsurgical resection of cavernomas causing epilepsy

2010 ◽  
Vol 29 (3) ◽  
pp. E16 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
W. Richard Marsh ◽  
Fredric B. Meyer ◽  
Gregory A. Worrell
Keyword(s):  
Seizure Frequency ◽  
Intractable Epilepsy ◽  
Survey Study ◽  
Intractable Seizures ◽  
Select Group ◽  
Age At Surgery ◽  
Survey Results ◽  
Microsurgical Resection

Object Microsurgical resection of supratentorial cavernomas associated with intractable epilepsy is performed frequently. Despite its common occurrence, little is known about patient perceptions of microsurgical resection for cavernomas. This survey study was performed to investigate patient perceived outcome after surgery for cavernomas associated with intractable epilepsy. Methods The authors' surgical database was searched for cavernoma resection performed between 1971 and July of 2006. Of the initial 173 patients identified, 102 met criteria for medically intractable seizures. These 102 patients were then mailed a survey to determine follow-up and patient satisfaction. Thirty-nine surveys were returned as undeliverable, and 30 (48%) of the remaining 63 patients responded. Results The average age at surgery for patients responding to this survey was 40 ± 16 years compared with 35 ± 15 years for all 102 patients. At prolonged follow-up, 87% of patients reported being seizure-free. Of those with seizures, 2 (7%) reported being nearly seizure-free (rare disabling seizures), 2 (7%) believed they had a worthwhile improvement in seizure frequency, and no patient (0%) in this series believed they did not have a worthwhile improvement in seizure frequency. Ninety percent of responders stated they definitely, and 10% probably, would have surgery again. No patient responded that they probably or definitely would not have epilepsy surgery. Mean clinical follow-up was 36 ± 8 months and survey follow-up was 97 ± 13 months for these 30 patients. Use of the mail-in survey increased follow-up length 2.7 times longer compared with clinical follow-up. Conclusions It is clear from this select group of survey responders that patients undergoing surgery for cavernomas associated with medically intractable epilepsy are happy they underwent surgery (100%) and had excellent surgical outcomes (87% seizure-free) at prolonged follow-up of 97 ± 13 months. These survey results support that microsurgical resection for cavernomas is highly effective and significantly improves these patients' quality of life.

scholarly journals Magnetic resonance imaging–guided laser interstitial thermal therapy as treatment for intractable insular epilepsy in children

2017 ◽  
Vol 20 (6) ◽  
pp. 575-582 ◽  
Author(s):  
M. Scott Perry ◽  
David J. Donahue ◽  
Saleem I. Malik ◽  
Cynthia G. Keator ◽  
Angel Hernandez ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Medical Center ◽  
Surgical Techniques ◽  
Intractable Epilepsy ◽  
Vascular Supply ◽  
Thermal Therapy ◽  
Attractive Alternative ◽  
Class Iii ◽  
Laser Interstitial Thermal Therapy

OBJECTIVESeizure onset within the insula is increasingly recognized as a cause of intractable epilepsy. Surgery within the insula is difficult, with considerable risks, given the rich vascular supply and location near critical cortex. MRI-guided laser interstitial thermal therapy (LiTT) provides an attractive treatment option for insular epilepsy, allowing direct ablation of abnormal tissue while sparing nearby normal cortex. Herein, the authors describe their experience using this technique in a large cohort of children undergoing treatment of intractable localization-related epilepsy of insular onset.METHODSThe combined epilepsy surgery database of Cook Children’s Medical Center and Dell Children’s Hospital was queried for all cases of insular onset epilepsy treated with LiTT. Patients without at least 6 months of follow-up data and cases preoperatively designated as palliative were excluded. Patient demographics, presurgical evaluation, surgical plan, and outcome were collected from patient charts and described.RESULTSTwenty patients (mean age 12.8 years, range 6.1–18.6 years) underwent a total of 24 LiTT procedures; 70% of these patients had normal findings on MRI. Patients underwent a mean follow-up of 20.4 months after their last surgery (range 7–39 months), with 10 (50%) in Engel Class I, 1 (5%) in Engel Class II, 5 (25%) in Engel Class III, and 4 (20%) in Engel Class IV at last follow-up. Patients were discharged within 24 hours of the procedure in 15 (63%) cases, in 48 hours in 6 (24%) cases, and in more than 48 hours in the remaining cases. Adverse functional effects were experienced following 7 (29%) of the procedures: mild hemiparesis after 6 procedures (all patients experienced complete resolution or had minimal residual dysfunction by 6 months), and expressive language dysfunction after 1 procedure (resolved by 3 months).CONCLUSIONSTo their knowledge, the authors present the largest cohort of pediatric patients undergoing insular surgery for treatment of intractable epilepsy. The patient outcomes suggest that LiTT can successfully treat intractable seizures originating within the insula and offers an attractive alternative to open resection. This is the first description of LiTT applied to insular epilepsy and represents one of only a few series describing the use of LiTT in children. The results indicate that seizure reduction after LiTT compares favorably to that after conventional open surgical techniques.

scholarly journals Ultrasound-tailored functional hemispherectomy for surgical control of seizures in children

1996 ◽  
Vol 1 (5) ◽  
pp. E4
Author(s):  
Paul M. Kanev ◽  
Catherine M. Foley ◽  
Dan Miles
Keyword(s):  
The Body ◽  
Temporal Lobectomy ◽  
Surgical Time ◽  
Postoperative Fever ◽  
Intractable Seizures ◽  
Functional Hemispherectomy ◽  
Fever Syndromes ◽  
Long Term Follow Up

Functional hemispherectomy techniques have been designed to minimize the long-term complications of anatomical resection without reducing the effectiveness of seizure control. The authors have used an ultrasound-guided approach tailored to combine temporal lobectomy with frontal and occipital disconnections with a central topectomy of the lateral, insular, and interhemispheric cortex. This technique achieves a comprehensive functional disconnection and minimizes entrance and manipulation within the body of the lateral ventricle. Eight patients ranging in age from 10 months to 23 years with congenital paresis and medically intractable seizures underwent functional hemispherectomy via this technique. The average surgical time was 4.5 hours, and blood loss ranged from 90 to 400 ml. All but one patient was discharged after 5 days. Postoperative fever syndromes, aseptic meningitis, and infection were avoided. On long-term follow-up evaluation (range l8-60 months, mean 38 months), seven of eight patients remain seizure free and were not on a course of anticonvulsant agents. Advantages of this technique include avoiding entrance within the ventricle, a more predictable postoperative period, and reduced postoperative complications.

scholarly journals Pediatric epilepsy surgery: could age be a predictor of outcomes?

2016 ◽  
Vol 18 (2) ◽  
pp. 235-241 ◽  
Author(s):  
Benoit Jenny ◽  
Nicolas Smoll ◽  
Yassine El Hassani ◽  
Shahan Momjian ◽  
Claudio Pollo ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Pediatric Epilepsy ◽  
University Hospitals ◽  
Chi Square ◽  
Intractable Seizures ◽  
Antiepileptic Medication ◽  
Pediatric Epilepsy Surgery ◽  
Chi Square Test ◽  
Free Rate

OBJECTIVE Like adults, many children suffering from intractable seizures benefit from surgical therapy. Although various reports indicate that early intervention may avoid severe developmental consequences often associated with intractable epilepsy, surgery is still considered a last option for many children. In this retrospective study, the authors aimed to determine whether pediatric epilepsy surgery, in particular during the first years of life, relates to measurable benefits. METHODS Data from 78 patients (age range 5 months to 17 years) who underwent epilepsy surgery at the Geneva and Lausanne University Hospitals between 1997 and 2012 were reviewed retrospectively. Patients were dichotomized into 2 groups: infants (≤ 3 years of age, n = 19), and children/adolescents (4–17 years of age, n = 59). Compared with children/adolescents, infants more often had a diagnosis of dysplasia (37% vs 10%, respectively; p < 0.05, chi-square test). RESULTS The overall seizure-free rate was 76.9%, with 89.5% in infants and 72.9% in the children/adolescents group. Infants were 2.76 times as likely to achieve seizure-free status as children/adolescents. Postoperative antiepileptic medication was reduced in 67.9% of patients. Only 11.4% of the patients were taking more than 2 antiepileptic drugs after surgery, compared with 43% before surgery (p < 0.0001). The overall complication rate was 15.1% (6.4% transient hemiparesis), and no major complications or deaths occurred. CONCLUSIONS The data show a high seizure-free rate in children ≤ 3 years of age, despite a higher occurrence of dysplastic, potentially ill-defined lesions. Pediatric patients undergoing epilepsy surgery can expect a significant reduction in their need for medication. Given the excellent results in the infant group, prospective studies are warranted to determine whether age ≤ 3 years is a predictor for excellent surgical outcome.

Outcomes of epilepsy surgery in the older population: not too old, not too late

2021 ◽  
pp. 1-10
Author(s):  
Panagiotis Kerezoudis ◽  
Rohin Singh ◽  
Veronica Parisi ◽  
Gregory A. Worrell ◽  
Kai J. Miller ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Mortality Rates ◽  
Temporal Lobectomy ◽  
Administrative Database ◽  
Seizure Freedom ◽  
Mesial Temporal Sclerosis ◽  
Complication Rates ◽  
Older Population ◽  
Safety And Efficacy

OBJECTIVE The prevalence of epilepsy in the older adult population is increasing. While surgical intervention in younger patients is supported by level I evidence, the safety and efficacy of epilepsy surgery in older individuals is less well established. The aim of this study was to evaluate seizure freedom rates and surgical outcomes in older epilepsy patients. METHODS The authors’ institutional electronic database was queried for patients older than 50 who had undergone epilepsy surgery during 2002–2018. Cases were grouped into 50–59, 60–69, and 70+ years old. Seizure freedom at the last follow-up constituted the primary outcome of interest. The institutional analysis was supplemented by a literature review and meta-analysis (random effects model) of all published studies on this topic as well as by an analysis of complication rates, mortality rates, and cost data from a nationwide administrative database (Vizient Inc., years 2016–2019). RESULTS A total of 73 patients (n = 16 for 50–59 years, n = 47 for 60–69, and n = 10 for 70+) were treated at the authors’ institution. The median age was 63 years, and 66% of the patients were female. At a median follow-up of 24 months, seizure freedom was 73% for the overall cohort, 63% for the 50–59 group, 77% for the 60–69 group, and 70% for the 70+ group. The literature search identified 15 additional retrospective studies (474 cases). Temporal lobectomy was the most commonly performed procedure (73%), and mesial temporal sclerosis was the most common pathology (52%), followed by nonspecific gliosis (19%). The pooled mean follow-up was 39 months (range 6–114.8 months) with a pooled seizure freedom rate of 65% (95% CI 59%–72%). On multivariable meta-regression analysis, an older mean age at surgery (coefficient [coeff] 2.1, 95% CI 1.1–3.1, p < 0.001) and the presence of mesial temporal sclerosis (coeff 0.3, 95% CI 0.1–0.6, p = 0.015) were the most important predictors of seizure freedom. Finally, analysis of the Vizient database revealed mortality rates of 0.5%, 1.1%, and 9.6%; complication rates of 7.1%, 10.1%, and 17.3%; and mean hospital costs of $31,977, $34,586, and $40,153 for patients aged 50–59, 60–69, and 70+ years, respectively. CONCLUSIONS While seizure-free outcomes of epilepsy surgery are excellent, there is an expected increase in morbidity and mortality with increasing age. Findings in this study on the safety and efficacy of epilepsy surgery in the older population may serve as a useful guide during preoperative decision-making and patient counseling.

Differential diagnosis of thyroid diseases by the x-ray fluorescent method

2019 ◽  
Vol 43 (3) ◽  
pp. 38-42
Author(s):  
I. О. Tomashevsky
Keyword(s):  
Autoimmune Thyroiditis ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Thyroid Diseases ◽  
Benign Tumors ◽  
Commercial Sample ◽  
X Ray ◽  
Thyroid Adenomas ◽  
The Usa ◽  
History Of

Intrathyroid stable iodine (ISI) was measured in 249 women aged 36 to 55 living in Moscow. 179 of these suffered from thyroid tumors and autoimmune thyroiditis and 70 without history of thyroid diseases with normal thyroid status confirmed by clinical laboratory data and ISI values of at least 200 pg/g, considered as the critical, were controls. ISI concentrations were measured using a Russian commercial sample for noninvasive x-ray fluorescent analysis. Using the same device, ISI was measured in thyroid samples with cancer and benign tumors, embedded in paraffin blocks, sent from the USA (n - 47) and Russia (n = 126); in addition, these samples were examined histologically. ISI concentrations were lower in cancer, thyroid adenomas, and autoimmune thyroiditis than in control. An ISI concentration lower than 200 pg/g indicates autoimmune thyroiditis with a probability of 96%. Use of L- thyroxin test increases the probability of the disease recognition to 98%.

Long-term Seizure Outcome in Reoperation after Failure of Epilepsy Surgery

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 873-880 ◽  
Author(s):  
Jorge A. González-Martínez ◽  
Teeradej Srikijvilaikul ◽  
Dileep Nair ◽  
William E. Bingaman
Keyword(s):  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Cortical Dysplasia ◽  
Categorical Variables ◽  
Seizure Outcome ◽  
Mesial Temporal Sclerosis ◽  
Long Term Outcome ◽  
The Relationship

Abstract OBJECTIVE Treatment of patients who fail epilepsy surgery is problematic. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. We present our long-term outcome series of highly investigated patients who failed resective epilepsy surgery and subsequently underwent reoperative resective procedures. METHODS We performed a retrospective consecutive analysis of patients who underwent reoperative procedures because of medically intractable epilepsy at our institution from 1990 to 2001. Seventy patients underwent reoperative epilepsy surgery, with 57 patients having a minimum follow-up period of 2 years. We assessed the relationship between seizure outcome and categorical variables using χ2 and Fisher's exact tests, and the relationship between outcome and continuous variables using a Wilcoxon rank-sum test. Statistical significance was set at a P value of 0.05. RESULTS Of the 57 patients (29 male and 28 female patients), the age of seizure onset ranged from 3 months to 39 years (mean, 10.7 ± 10.3 yr; median, 7 yr). The mean age at reoperation was 24.7 ± 12 years (range, 4–50 yr). The interval between first and second resection was 7 days to 16 years. The follow-up period ranged from 24 to 228 months (mean, 128 mo; mode, 132 mo). Seizure outcome was classified according to Engel's classification. Fifty-two percent of the patients had a favorable outcome (38.6% were Class I and 14.0% were Class II). Patients with tumors as their initial pathology had better outcome compared with patients with focal cortical dysplasia and mesial temporal sclerosis (P &lt; 0.05). CONCLUSION Reoperation should be considered in selected patients failing epilepsy resective surgery because approximately 50% of patients may have benefit. Patients with cortical dysplasia and mesial temporal sclerosis are less likely to improve after reoperation.

Hemispherectomy for intractable seizures: long-term results in 17 patients followed for up to 38 years

1993 ◽  
Vol 78 (5) ◽  
pp. 733-740 ◽  
Author(s):  
Keith G. Davies ◽  
Robert E. Maxwell ◽  
Lyle A. French
Keyword(s):  
Intractable Epilepsy ◽  
Late Complications ◽  
Long Term Results ◽  
Recurrent Bleeding ◽  
Frontal Pole ◽  
Content Type ◽  
Intractable Seizures ◽  
Lost To Follow Up

✓ Seventeen patients who underwent hemispherectomy for intractable epilepsy between 1950 and 1971 were reviewed to evaluate outcome for seizure control and the development of late complications. Sixteen had complete resection and in one the frontal pole was preserved. The follow-up period was 19 to 38 years (mean 28 years). One patient was lost to follow-up review 10 years after surgery. Three patients had died but none of the deaths were related to the surgery or to epilepsy. Ten patients had no postoperative complications, and three developed late complications: two had elevated intracranial pressure with enlargement of the remaining lateral ventricle after 13 and 16 years, and one had recurrent bleeding into the cerebrospinal fluid after 6 years. All were treated surgically and have since remained well. Eight patients (47%) had no seizures after surgery and eight (47%) were almost seizure-free. It is concluded that classical hemispherectomy is an effective operation for control of some types of epilepsy. The late complications, which occurred in 17% of the cases in this series, can be successfully treated. This series presents the longest follow-up results after hemispherectomy reported to date.

LONG-TERM SEIZURES AND QUALITY OF LIFE AFTER EPILEPSY SURGERY COMPARED WITH MATCHED CONTROLS

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 326-335 ◽  
Author(s):  
Knut Stavem ◽  
Helge Bjørnæs ◽  
Iver A. Langmoen
Keyword(s):  
Quality Of Life ◽  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Two Dimensions ◽  
Three Dimensions ◽  
Seizure Type ◽  
Seizure Outcome

Abstract OBJECTIVE We compared long-term seizure outcome and health-related quality of life (HRQoL) of patients who underwent epilepsy surgery and matched medically treated nonsurgical controls with intractable epilepsy. METHODS Medically treated controls were identified for patients operated on for epilepsy between January 1, 1949 and December 31, 1992. We used a matched cohort design, matching for age, sex, and seizure type. The analysis was based on 70 complete matching pairs. HRQoL was assessed with the Quality of Life in Epilepsy Inventory 89 questionnaire an average of 15 years after surgery. RESULTS Among surgery patients, 48% were seizure-free during the previous year compared with 19% of the controls (P = 0.0004). Fewer surgery patients used antiepileptic drugs (70%) than controls (93%). The odds of being seizure-free were higher for surgery patients in total and in subgroups divided according to length of follow-up. The mean HRQoL for surgery patients was higher in five of the 17 Quality of Life in Epilepsy Inventory 89 dimensions and worse in none. Among patients with more than 7 years of follow-up, HRQoL was better in three dimensions and worse in none. Among patients with 7 years of follow-up or less, HRQoL was better in two dimensions and worse in the language dimension of the Quality of Life in Epilepsy Inventory 89. CONCLUSION After an average of more than 15 years of follow-up, epilepsy surgery patients had fewer seizures, used less antiepileptic medication, and had better HRQoL in several dimensions of the Quality of Life in Epilepsy Inventory 89 instrument than matched medically treated controls with refractory epilepsy, although possibly at a slight disadvantage in the language dimension among those with 7 years of follow-up or less.

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