ĐẶC ĐIỂM SUY GIẢM CHỨC NĂNG TRÍ NHỚ TRÊN BỆNH NHÂN ĐỘNG KINH TRƯỞNG THÀNH TẠI BỆNH VIỆN BẠCH MAI

Bệnh động kinh gây hậu quả là cơn động kinh và có thể gây tổn thương các chức năng cao cấp của não trong đó có chức năng trí nhớ. Điều này dẫn đến suy giảm chất lượng cuộc sống đối với bệnh nhân động kinh. Mục tiêu: Mô tả đặc điểm lâm sàng suy giảm chức năng trí nhớ trên bệnh nhân động kinh trưởng thành. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang trên 144 bệnh nhân được chẩn đoán động kinh theo tiêu chuẩn của Liên hội chống động kinh quốc tế (International League Against Epilepsy) tại bệnh viện Bạch Mai từ tháng 07 năm 2020 đến tháng 07 năm 2021. Kết quả: Có 78 bệnh nhân nam và 66 bệnh nhân nữ với độ tuổi trung bình là 44,2 ± 9,1.Độ tuổi khởi cơn động kinh lần đầu hay gặp nhất ở nhóm dưới 18 tuổi, sau 60 tuổi thì tỷ lệ này cũng có xu hướng tăng lên. Trong nhóm bệnh nhân nghiên cứu, bệnh nhân xuất hiện cơn động kinh cục bộ đơn thuần là nhiều nhất (38,9%,), số lượng bệnh nhân xuất hiện cơn cục bộ phức hợp ít nhất (11,1%). Tỷ lệ bệnh nhân động kinh bị suy giảm trí nhớ là 34,0%, trong đó nam giới chiếm 33,3%, nữ giới chiếm 34,8%, không có sự khác biệt về tỉ lệ suy giảm trí nhớ ở 2 giới.Bệnh nhân có tần suất cơn động kinh dày tỷ lệ bị suy giảm trí nhớ là 58,3%, bệnh nhân bị bệnh kéo dài trên 5 năm tỷ lệ suy giảm trí nhớ là 55,8%. Kết luận: Trong nghiên cứu của chúng tôi, bệnh nhân động kinh có tỷ lệ suy giảm trí nhớ tương đối cao, chiếm 34,0%. Bệnh nhân có thời gian mắc bệnh càng lâu, tần suất xuất hiện cơn động kinh càng dày thì tỷ lệ suy giảm trí nhớ càng cao, vì vậy cần có sự can thiệp điều trị tích cực hơn ở nhóm này.

Can intraoperative electrocorticography be used to minimize the extent of resection in patients with temporal lobe epilepsy associated with hippocampal sclerosis?

OBJECTIVE Tailored surgery to extensively resect epileptogenic lesions using intraoperative electrocorticography (ioECoG) may improve seizure outcomes. However, resection of large areas is associated with decreased memory function postoperatively. The authors assessed whether ioECoG could provide useful information on how to minimize the focus resection and obtain better seizure outcomes without memory deterioration. They examined the postoperative seizure-free period and memory alteration in a retrospective cohort of patients with mesial temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) in whom the extent of removal was determined using ioECoG findings. METHODS The authors enrolled 82 patients with TLE associated with HS who were treated surgically. Transsylvian amygdalohippocampectomy was indicated as the first step. When visual inspection identified interictal epileptic discharges from the lateral temporal lobe on ioECoG, anterior temporal lobectomy (ATL) was eventually performed. The patients were divided into the selective amygdalohippocampectomy (SA, n = 40) and ATL (n = 42) groups. Postoperative seizure outcomes were assessed at 1, 2, 3, 5, and 7 years postoperatively using the International League Against Epilepsy classification. The Kaplan-Meier survival analysis was applied to evaluate the period of seizure recurrence between the SA and ATL groups. Factors attributed to seizure recurrence were analyzed using the Cox proportional hazards model, and they were as follows: epileptic focal laterality; age at seizure onset (< 10 or ≥ 10 years old); seizure frequency (more than weekly or less than weekly seizures); history of focal to bilateral tonic-clonic seizure; infectious etiology; and surgical procedure. The Wechsler Memory Scale–Revised was used to evaluate memory function pre- and postoperatively. RESULTS Seizure outcomes were significantly worse in the SA group than in the ATL group at 2 years postoperatively (p = 0.045). The International League Against Epilepsy class 1 outcomes at 7 years postoperatively in the SA and ATL groups were 63% and 81%, respectively. Kaplan-Meier analysis showed that seizure recurred significantly earlier in the SA group than in the ATL group (p = 0.031). The 2-way ANOVA analysis was used to compare the SA and ATL groups in each memory category, and revealed that there was no significant difference regardless of the side of surgery. CONCLUSIONS Visual assessment of ioECoG cannot be used as an indicator to minimize epileptic focus resection in patients with TLE associated with HS. ATL is more effective in obtaining seizure-free outcomes; however, both ATL and SA can preserve memory function.

Oral dyspraxia in self-limited epilepsy with centrotemporal spikes: a comparative study with a control group

ABSTRACT Background: self-limited epilepsy with centrotemporal spikes, previously considered benign focal childhood epilepsy with centrotemporal spikes show clinical signs of involvement of Rolandic areas, mainly lower area, which may affect the planning and execution of motor sequences. Objective: This study aimed to evaluated oral praxis in children with self-limited epilepsy with centrotemporal spikes and compare to the age-matched control group. Methods: This was a descriptive study with 74 children with self-limited epilepsy with centrotemporal spikes, with the classical forms according to International League Against Epilepsy, and between 4 and 15 years of age, selected from the child neurology outpatient clinic of the Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and 239 age-matched and educational level-matched (convenience sampling) control children. All children were submitted to the battery of oral volitional movements, which consisted of 44 tests for oral movement (tongue, lip, cheek, jaw, and palate) and 34 phonemes and consonant cluster tasks, with simple and sequenced oral movements. Results: The mean age and standard deviation (SD) of children with epilepsy was 9.08 years (SD 2.55) and of controls 9.61 years (SD 3.12). The results showed significant differences between the groups with a poorer performance of children with epilepsy compared to children without epilepsy in simple and particularly in sequenced movements. Conclusion: These findings can be attributed to the genetically determined immaturity of cortical structures related to motor planning in children with self-limited epilepsy with centrotemporal spikes.

P.094 Referral Practices for Epilepsy Surgery in Pediatric Patients: A North American Study

Background: The International League Against Epilepsy recommends patients with drug resistant epilepsy (DRE) be referred for surgical evaluation, however prior literature suggests this is an underutilized intervention. This study captures practices of North American pediatric neurologists regarding the management of DRE and factors which may promote or limit referrals for epilepsy surgical evaluation. Methods: A REDCap survey distributed via the Child Neurology Society mailing list to pediatric neurologists practicing in North America. “R” was used to conduct data analyses. Ethics approval from the CHEO REB was granted prior to the start of data collection. Results: 102 pediatric neurologists responded, 77% of whom currently practice in the United States. 73% of respondents reported they would refer a patient for surgical consultation after two failed medications. Of all potential predictors tested in a logistic regression model, low referral volume was the only predictor of whether participants refer patients after more than three failed medications. Conclusions: Pediatric neurologists demonstrate fair knowledge of formal recommendations to refer patients for surgical evaluation after two failed medication trials. Other modifiable factors reported, especially family perceptions of epilepsy surgery, should be prioritized when developing tools to enhance effective referrals and increase utilization of epilepsy surgery in the management of pediatric DRE.