Corpus callosotomy for treatment of drug-resistant epilepsy: a review of 16 pediatric cases in northern Vietnam

OBJECTIVEThe aim of this study was to evaluate postoperative seizure outcome in children with drug-resistant epilepsy not eligible for focal resection who underwent corpus callosotomy.METHODSThe study included 16 patients undergoing corpus callosotomy between September 2015 and May 2018. Seizure semiology and frequency, psychomotor status, and video electroencephalography and imaging findings were evaluated for all patients.RESULTSOf the 16 patients who underwent callosotomy during the study period, 11 underwent complete callosotomy and 5 underwent anterior only. Seizure improvement greater than 75% was achieved in 37.5% of patients, and another 50% of patients had seizure improvement of 50%–75%. No sustained neurological deficits were observed in these patients. There were no significant complications. Duration of postoperative follow-up ranged from 12 to 44 months.CONCLUSIONSCorpus callosotomy is an effective treatment for selected patients with drug-resistant epilepsy not eligible for focal resection in resource-limited settings. Fostering and developing international epilepsy surgery centers should remain a high priority for the neurosurgical community at large.

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Predictors of seizure outcome following resective surgery for drug-resistant epilepsy associated with focal gliosis

Journal of Neurosurgery ◽

10.3171/2018.3.jns172949 ◽

2019 ◽

Vol 130 (6) ◽

pp. 2071-2079

Author(s):

Gopal K. Dash ◽

Chaturbhuj Rathore ◽

Malcolm K. Jeyaraj ◽

Pandurang Wattamwar ◽

Sankara P. Sarma ◽

...

Keyword(s):

Postoperative Outcome ◽

Posterior Region ◽

Seizure Outcome ◽

Drug Resistant ◽

Resective Surgery ◽

Common Etiology ◽

Neurological Infections ◽

Drug Resistant Epilepsy ◽

Postoperative Seizure

OBJECTIVEThe authors studied the clinical characteristics and postoperative outcomes of drug-resistant epilepsy associated with focal gliosis.METHODSFrom their epilepsy surgery database, the authors selected the patients with drug-resistant epilepsy and MRI-defined focal gliosis who underwent focal resective surgery. All patients underwent standard presurgical evaluation. Intracranial electroencephalography (EEG) was performed in patients with discordant presurgical data, ill-defined lesions, and lesions close to eloquent regions. Completeness of resection was defined on the basis of extraoperative and intraoperative electrocorticography studies. Favorable postoperative outcome was defined as Engel class I outcome during the last 2 years of follow-up.RESULTSSixty-six patients fulfilled inclusion criteria. An initial precipitating injury was present in 38 (57.6%) patients, mainly in the form of perinatal injury (n = 10), trauma (n = 10), and meningoencephalitis (n = 8). Gliosis involved a single lobe in 38 (57.6%) patients and 2 adjacent lobes in 14 (21.2%) patients; the remaining 14 (21.2%) patients had multilobar gliosis. In patients with unilobar or bilobar gliosis, the posterior region of the head was involved in 34 (65%) patients and the frontal lobes in 12 (23%) patients. During a median follow-up of 4 years (range 2–9 years), 41 (62.1%) patients had favorable outcome. On multivariate analysis, the presence of a well-defined aura (p = 0.019), electrocorticographically defined completeness of resection (p = 0.024), and normal postoperative EEG findings at 1 year (p = 0.003) were predictive of favorable postoperative seizure outcome.CONCLUSIONSFocal gliosis is a common etiology for drug-resistant extratemporal epilepsy in developing countries and is most often located in the posterior region of the head. The majority of these patients have perinatal injuries or neurological infections as initial precipitating injuries. Patients with focal gliosis have good postoperative seizure outcomes after well-planned resective surgery.

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Seizure Outcomes in Patients With Surgically Treated Cerebral Arteriovenous Malformations

Neurosurgery ◽

10.1227/neu.0000000000000919 ◽

2015 ◽

Vol 77 (5) ◽

pp. 762-768 ◽

Cited By ~ 16

Author(s):

Christian von der Brelie ◽

Matthias Simon ◽

Jonas Esche ◽

Johannes Schramm ◽

Azize Boström

Keyword(s):

Life Quality ◽

Seizure Outcome ◽

Seizure Freedom ◽

Common Symptom ◽

Extensive Resection ◽

Chronic Epilepsy ◽

Epilepsy Classification ◽

Drug Resistant Epilepsy ◽

Postoperative Seizure

Abstract BACKGROUND: Epilepsy is the second most common symptom in cerebral arteriovenous malformation (AVM) patients. The consecutive reduction of life quality is a clinically underrated problem because treatment usually focuses on the prevention of intracerebral hemorrhage. OBJECTIVE: To evaluate postoperative seizure outcome with the aim of more accurate counseling for postoperative seizure outcome. METHODS: From 1985 to 2012, 293 patients with an AVM were surgically treated by J.S. One hundred twenty-six patients with preoperative seizures or epilepsy could be identified; 103 of 126 had a follow-up of at least 12 months and were included in the analysis. The different epilepsy subtypes were categorized (sporadic seizures, chronic epilepsy, drug-resistant epilepsy [DRE]). Preoperative workup and surgical technique were evaluated. Seizure outcome was analyzed by using International League Against Epilepsy classification. RESULTS: Sporadic seizures were identified in 41% of patients (chronic epilepsy and DRE were identified in 36% and 23%, respectively). Detailed preoperative epileptological workup was done in 13%. Seizure freedom was achieved in 77% (79% at 5 years, 84% at 10 years). Outcome was significantly poorer in DRE cases. More extensive resection was performed in 11 cases with longstanding symptoms (>24 months) and resulted in better seizure outcome as well as the short duration of preoperative seizure history. CONCLUSION: Patients presenting with AVM-associated epilepsy have a favorable seizure outcome after surgical treatment. Long-standing epilepsy and the progress into DRE markedly deteriorate the chances to obtain seizure freedom and should be considered an early factor in establishing the indication for AVM removal.

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Tailored multilobar disconnective epilepsy surgery in the posterior quadrant

Journal of Neurosurgery ◽

10.3171/2019.1.jns183103 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1345-1357 ◽

Cited By ~ 3

Author(s):

Michele Rizzi ◽

Martina Revay ◽

Piergiorgio d’Orio ◽

Pina Scarpa ◽

Valeria Mariani ◽

...

Keyword(s):

Safety Profile ◽

Class I ◽

Seizure Outcome ◽

Seizure Freedom ◽

Type I ◽

Drug Resistant ◽

Presurgical Evaluation ◽

Posterior Quadrant ◽

Drug Resistant Epilepsy

OBJECTIVESurgical treatment of drug-resistant epilepsy originating from the posterior quadrant (PQ) of the brain often requires large multilobar resections, and disconnective techniques have been advocated to limit the risks associated with extensive tissue removal. Few previous studies have described a tailored temporoparietooccipital (TPO) disconnective approach; only small series with short postoperative follow-ups have been reported. The aim of the present study was to present a tailored approach to multilobar PQ disconnections (MPQDs) for epilepsy and to provide details about selection of patients, presurgical investigations, surgical technique, treatment safety profile, and seizure and cognitive outcome in a large, single-center series of patients with a long-term follow-up.METHODSIn this retrospective longitudinal study, the authors searched their prospectively collected database for patients who underwent MPQD for drug-resistant epilepsy in the period of 2005–2017. Tailored MPQDs were a posteriori grouped as follows: type I (classic full TPO disconnection), type II (partial TPO disconnection), type III (full temporooccipital [TO] disconnection), and type IV (partial TO disconnection), according to the disconnection plane in the occipitoparietal area. A bivariate statistical analysis was carried out to identify possible predictors of seizure outcome (Engel class I vs classes II–IV) among several presurgical, surgical, and postsurgical variables. Preoperative and postoperative cognitive profiles were also collected and evaluated.RESULTSForty-two consecutive patients (29 males, 24 children) met the inclusion criteria. According to the presurgical evaluation (including stereo-electroencephalography in 13 cases), 12 (28.6%), 24 (57.1%), 2 (4.8%), and 4 (9.5%) patients received a type I, II, III, or IV MPQD, respectively. After a mean follow-up of 80.6 months, 76.2% patients were in Engel class I at last contact; at 6 months and 2 and 5 years postoperatively, Engel class I was recorded in 80.9%, 74.5%, and 73.5% of cases, respectively. Factors significantly associated with seizure freedom were the occipital pattern of seizure semiology and the absence of bilateral interictal epileptiform abnormalities at the EEG (p = 0.02). Severe complications occurred in 4.8% of the patients. The available neuropsychological data revealed postsurgical improvement in verbal domains, whereas nonunivocal outcomes were recorded in the other functions.CONCLUSIONSThe presented data indicate that the use of careful anatomo-electro-clinical criteria in the presurgical evaluation allows for customizing the extent of surgical disconnections in PQ epilepsies, with excellent results on seizures and an acceptable safety profile.

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P.042 Safety and efficacy of stereoelectroencephalography in pediatric epilepsy surgery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.142 ◽

2019 ◽

Vol 46 (s1) ◽

pp. S25

Author(s):

CA Elliott ◽

K Narvacan ◽

J Kassiri ◽

S Carline ◽

B Wheatley ◽

...

Keyword(s):

Pediatric Epilepsy ◽

Seizure Outcome ◽

Neurogenic Pulmonary Edema ◽

Epileptogenic Zone ◽

Drug Resistant ◽

Presurgical Evaluation ◽

Pediatric Drug ◽

Safety And Efficacy ◽

Drug Resistant Epilepsy

Background: There are few published reports on the safety and efficacy of stereoelectroencephalography (SEEG) in the presurgical evaluation of pediatric drug-resistant epilepsy. Our objective was to describe institutional experience with pediatric SEEG in terms of (1) insertional complications, (2) identification of the epileptogenic zone and (3) seizure outcome following SEEG-tailored resections. Methods: Retrospective review of 29 patients pediatric drug resistant epilepsy patients who underwent presurgical SEEG between 2005 – 2018. Results: 29 pediatric SEEG patients (15 male; 12.4 ± 4.6 years old) were included in this study with mean follow-up of 6.0 ± 4.1 years. SEEG-related complications occurred in 1/29 (3%)—neurogenic pulmonary edema. A total of 190 multi-contact electrodes (mean of 7.0 ± 2.5per patient) were implanted across 30 insertions which captured 437 electrographic seizures (mean 17.5 ± 27.6 per patient). The most common rationale for SEEG was normal MRI with surface EEG that failed to identify the EZ (16/29; 55%). SEEG-tailored resections were performed in 24/29 (83%). Engel I outcome was achieved following resections in 19/24 cases (79%) with 5.9 ± 4.0 years of post-operative follow-up. Conclusions: Stereoelectroencephalography in presurgical evaluation of pediatric drug-resistant epilepsy is a safe and effective way to identify the epileptogenic zone permitting SEEG-tailored resection.

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Resective surgery for drug-resistant posttraumatic epilepsy: predictors of seizure outcome

Journal of Neurosurgery ◽

10.3171/2019.7.jns191233 ◽

2020 ◽

Vol 133 (5) ◽

pp. 1568-1575

Author(s):

Xinghui He ◽

Yuguang Guan ◽

Feng Zhai ◽

Jian Zhou ◽

Tianfu Li ◽

...

Keyword(s):

Univariate Analysis ◽

Neurological Deficits ◽

Multivariate Logistic Regression Model ◽

Seizure Outcome ◽

Drug Resistant ◽

Prognosis Factors ◽

Posttraumatic Epilepsy ◽

Resective Surgery ◽

Class 1

OBJECTIVEThe object of this study was to evaluate surgical outcomes and prognosis factors in patients with drug-resistant posttraumatic epilepsy (PTE) who had undergone resective surgery.METHODSThe authors retrospectively reviewed the records of all patients with drug-resistant PTE who had undergone resective surgery at Sanbo Brain Hospital, Capital Medical University, in the period from January 2008 to December 2016. All patients had a follow-up period of at least 2 years. Seizure outcomes were evaluated according to the International League Against Epilepsy (ILAE) classification. Patients in ILAE classes 1 and 2 during the last 2 years of follow-up were classified as having a favorable outcome; patients in all other classes were considered to have an unfavorable outcome. Univariate analysis and a multivariate logistic regression model in a backward fashion were used to identify the potential predictors of seizure outcomes.RESULTSAmong 90 patients with a follow-up of 2–10 years (mean ± standard deviation, 5.79 ± 2.84 years), 70% (63 patients) were seizure free, of whom 68.9% (62 patients) had an ILAE class 1 outcome and 1.1% (1 patient) had an ILAE class 2 outcome. Permanent neurological deficits were observed in 10 patients (11.1%). Univariate and multivariate analyses revealed that only the duration of seizures ≤ 8 years was an independent predictor of a favorable seizure outcome (OR 0.34, 95% CI 0.13–0.92).CONCLUSIONSResective surgery is an effective treatment for patients with drug-resistant PTE with an acceptable incidence of complications. The information on prognosis factors suggests that early surgery may offer more benefits to patients with drug-resistant PTE.

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Quality of life in elderly patients after surgery for drug-resistant epilepsy – The impact of seizure outcome, neurological deficits and anxiety

Epilepsy & Behavior ◽

10.1016/j.yebeh.2020.107410 ◽

2020 ◽

Vol 112 ◽

pp. 107410

Author(s):

Daniel Delev ◽

Karlijn Hakvoort ◽

Alexander Grote ◽

Georg Neuloh ◽

Hans Clusmann ◽

...

Keyword(s):

Quality Of Life ◽

Elderly Patients ◽

Neurological Deficits ◽

Seizure Outcome ◽

Drug Resistant ◽

Drug Resistant Epilepsy ◽

The Impact

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Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy: a meta-analysis

Journal of Neurosurgery ◽

10.3171/2017.12.jns172331 ◽

2019 ◽

Vol 130 (4) ◽

pp. 1193-1202 ◽

Cited By ~ 2

Author(s):

Alvin Y. Chan ◽

John D. Rolston ◽

Brian Lee ◽

Sumeet Vadera ◽

Dario J. Englot

Keyword(s):

Meta Analysis ◽

Palliative Surgery ◽

Seizure Outcome ◽

Seizure Freedom ◽

Drug Resistant ◽

Corpus Callosotomy ◽

Mri Findings ◽

Drop Attacks ◽

Drop Attack ◽

Drug Resistant Epilepsy

OBJECTIVECorpus callosotomy is a palliative surgery for drug-resistant epilepsy that reduces the severity and frequency of generalized seizures by disconnecting the two cerebral hemispheres. Unlike with resection, seizure outcomes remain poorly understood. The authors systematically reviewed the literature and performed a meta-analysis to investigate rates and predictors of complete seizure freedom and freedom from drop attacks after corpus callosotomy.METHODSPubMed, Web of Science, and Scopus were queried for primary studies examining seizure outcomes after corpus callosotomy published over 30 years. Rates of complete seizure freedom or drop attack freedom were recorded. Variables showing a potential relationship to seizure outcome on preliminary analysis were subjected to formal meta-analysis.RESULTSThe authors identified 1742 eligible patients from 58 included studies. Overall, the rates of complete seizure freedom and drop attack freedom after corpus callosotomy were 18.8% and 55.3%, respectively. Complete seizure freedom was significantly predicted by the presence of infantile spasms (OR 3.86, 95% CI 1.13–13.23), normal MRI findings (OR 4.63, 95% CI 1.75–12.25), and shorter epilepsy duration (OR 2.57, 95% CI 1.23–5.38). Freedom from drop attacks was predicted by complete over partial callosotomy (OR 2.90, 95% CI 1.07–7.83) and idiopathic over known epilepsy etiology (OR 2.84, 95% CI 1.35–5.99).CONCLUSIONSThe authors report the first systematic review and meta-analysis of seizure outcomes in both adults and children after corpus callosotomy for epilepsy. Approximately one-half of patients become free from drop attacks, and one-fifth achieve complete seizure freedom after surgery. Some predictors of favorable outcome differ from those in resective epilepsy surgery.

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Utility of Epilepsy Surgery in Survivors of Childhood Cancer

Neuropediatrics ◽

10.1055/s-0041-1728653 ◽

2021 ◽

Author(s):

Ayat Siddiqui ◽

Amy L. McGregor ◽

James W. Wheless ◽

Paul Klimo ◽

Frederick A. Boop ◽

...

Keyword(s):

Cancer Survivors ◽

Childhood Cancer ◽

Epilepsy Surgery ◽

Seizure Control ◽

Childhood Cancer Survivors ◽

Seizure Outcome ◽

Drug Resistant ◽

Epilepsy Center ◽

Drug Resistant Epilepsy

AbstractResection of an epileptogenic focus improves seizure control in patients with drug-resistant epilepsy. There is little data available on usefulness of epilepsy surgery in childhood cancer survivors with drug-resistant epilepsy. To learn about seizure outcome after epilepsy surgery in childhood cancer survivors, we retrospectively reviewed charts of 42 children who were referred to an epilepsy center for surgical evaluation. Sixteen children (38%) were offered epilepsy surgery and 10 consented. Seizure outcome was classified based on International League Against Epilepsy outcome scale. All 10 children were having multiple seizures a month on therapeutic doses of three antiepilepsy drugs (AEDs). At a median follow-up of 5.6 years after epilepsy surgery, three children had class 1 outcome (no seizures), four had class 3 outcome (1–3 seizure days/year), and three had class 4 outcome (≥ 50% reduction in seizure frequency). One child was off AEDs, seven were on a single AED, and two were on three AEDs at their last follow-up. Epilepsy surgery had low morbidity and improved seizure control in childhood cancer survivors with drug-resistant epilepsy. Childhood cancer survivors with drug-resistant epilepsy should be referred to an epilepsy center for a higher level of care.

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P.099 Generator replacement with cardiac based VNS device in children with drug-resistant epilepsy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.377 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S47-S48

Author(s):

A Hadjinicolaou ◽

P Jain ◽

I Yau ◽

R Whitney ◽

JT Rutka ◽

...

Keyword(s):

Status Epilepticus ◽

Seizure Control ◽

Seizure Outcome ◽

Drug Resistant ◽

Seizure Onset ◽

Study Population ◽

The Mean ◽

Drug Resistant Epilepsy ◽

Generator Replacement

Background: We aimed to study the proportion of patients with DRE and pre-existing VNS device, who show improvement of at least one class in McHugh seizure outcome classification at last follow up after generator replacement with cardiac based VNS device. Methods: We retrospectively reviewed children with DRE with the older VNS model (102) who underwent battery replacement with the AspireSR®, model 106 since September 2016 at our institution. We assessed the seizure outcomes since the first VNS device insertion till the last follow up after AspireSR® (with cardiac-based seizure detection) using McHugh seizure outcome classification. Results: The study population was comprised of 15 patients. The mean age at seizure onset was 2.7 years old, with mean age of initial VNS1 placement being 10.1 years and mean age of replacement with VNS2 being 14.9 years of age. Three of the fifteen patients had reported status epilepticus prior to initial VNS insertion, and none reported episodes following insertion. Two patients showed at least one class improvement in McHugh seizure outcomes at last follow up after VNS2. Conclusions: Through our preliminary data at the present time, we note that the majority of our patients maintains their seizure control following replacement with VNS2 with a few showing improvement.

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