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

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.

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The ILAE definition of drug resistant epilepsy and its clinical applicability compared with “older” established definitions

Journal of Epileptology ◽

10.1515/joepi-2015-0025 ◽

2015 ◽

Vol 23 (1) ◽

pp. 39-44

Author(s):

Alexandra Rohracher ◽

Judith Dobesberger ◽

Claudia A. Granbichler ◽

Julia Höfler ◽

Giorgi Kuchukhidze ◽

...

Keyword(s):

Drug Resistance ◽

Epilepsy Surgery ◽

Treatment Process ◽

Drug Resistant ◽

Course Of Disease ◽

Clinical Applicability ◽

Specialized Center ◽

Drug Resistant Epilepsy ◽

Definition Of ◽

Mean Time

SUMMARY Background. Early identification of potential epilepsy surgery candidates is essential to the treatment process. Aim. To evaluate the clinical applicability of the ILAE definition of drug resistant epilepsy and its potential in identifying surgical candidates earlier compared to three established “older” definitions of drug resistant epilepsy. Material and Methods. Retrospective analysis of 174 patients who underwent epilepsy surgery between 1998 and 2009. Clinical factors and course of disease were extracted from patients' charts. Drug resistant epilepsy was classified according to four definitions and the time until fulfillment of criteria compared. Results. Mean time to fulfillment of criteria of drug resistant epilepsy ranged from 11.8 (standard deviation (SD) 9.8) to 15.6 years (SD 11.3). Time to drug resistance was significantly longer applying the only definition, requiring failure of three antiepileptic drugs (AEDs) (Canada definition), whereas time to fulfillment of all other definitions did not differ. Fifty percent of all patients experienced a seizure free period of ≥1 year prior to being classified as drug resistant, 13% entered another 1-year remission after fulfilling any criteria for drug resistance. Conclusion. We conclude that the ILAE definition identifies drug resistant epilepsy, with similar latency like two of three formerly used definitions. It is an easy applicable tool to minimize the delay of referral to a specialized center. Intermittent remissions delay assessment of drug resistance for all definitions and 13% of patients enter a remission despite established drug resistance.

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Deep brain stimulation for seizure control in drug-resistant epilepsy

Neurosurgical FOCUS ◽

10.3171/2018.4.focus1872 ◽

2018 ◽

Vol 45 (2) ◽

pp. E4 ◽

Cited By ~ 13

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.

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Post-Traumatic, Drug-Resistant Epilepsy and Review of Seizure Control Outcomes from Blinded, Randomized Controlled Trials of Brain Stimulation Treatments for Drug-Resistant Epilepsy

Cureus ◽

10.7759/cureus.744 ◽

2016 ◽

Cited By ~ 4

Author(s):

Michael Larkin ◽

R. Michael Meyer ◽

Nicholas S Szuflita ◽

Meryl A Severson ◽

Zachary T Levine

Keyword(s):

Randomized Controlled Trials ◽

Brain Stimulation ◽

Seizure Control ◽

Controlled Trials ◽

Drug Resistant ◽

Randomized Controlled ◽

Post Traumatic ◽

Drug Resistant Epilepsy

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

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190160 ◽

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.

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A Switch to Polyunsaturated Fatty Acid Based Ketogenic Diet Improves Seizure Control in Patients with Drug-resistant Epilepsy on the Mixed Fat Ketogenic Diet: A Retrospective Open Label Trial

Cureus ◽

10.7759/cureus.6399 ◽

2019 ◽

Cited By ~ 2

Author(s):

Janak Nathan ◽

Sonal Bailur ◽

Kuldeep Datay ◽

Suvasini Sharma ◽

Dhanashri Khedekar Kale

Keyword(s):

Fatty Acid ◽

Ketogenic Diet ◽

Polyunsaturated Fatty Acid ◽

Seizure Control ◽

Drug Resistant ◽

Open Label ◽

Open Label Trial ◽

Drug Resistant Epilepsy

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

Seizure ◽

10.1016/j.seizure.2020.11.005 ◽

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

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

BMJ Case Reports ◽

10.1136/bcr-2018-228348 ◽

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.

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