Posterior Disconnection in Early Infancy to Treat Intractable Epilepsy With Multilobar Cortical Dysplasia (original) (raw)
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Tailored disconnection based on presurgical evidence in catastrophic epilepsy: report of 2 cases
Journal of neurosurgery. Pediatrics, 2016
Catastrophic epilepsy in infants, often due to extensive cortical dysplasia, has devastating consequences with respect to brain development. Conventional lobar, multilobar, or hemispheric resection in these infants is challenging, carrying an increased operative risk compared with that in older children. Removing a larger tissue volume versus removing or disconnecting the epileptogenic region does not always guarantee better seizure outcome. The authors describe 2 infants with catastrophic epilepsy who benefited from individually tailored disconnections based on a hypothesized epileptogenic zone following intensive presurgical evaluation. Two infants with catastrophic epilepsy and epileptic spasms underwent leukotomies between 3 and 12 months of age. They were followed up postoperatively for 19-36 months. Both patients had 90%-100% seizure reduction and a significantly improved neurodevelopmental outcome without postoperative complication. Cortical malformation was seen in both pati...
Paediatric epilepsy surgery in the posterior cortex: a study of 62 cases
Epileptic disorders : international epilepsy journal with videotape, 2014
Past surgical series have emphasized the diagnostic complexity of posterior cortex epilepsy. Available data are sparse, especially in children, and most published series report a high number of surgical failures and post-operative neurological deficits. In this article, we present a paediatric cohort of 62 children who underwent surgery for drug resistant posterior cortex epilepsy before the age of 16 years with a mean post-operative follow-up of 6.94 years (range: 2-16). Mean age at epilepsy onset was 3.2 years and 28 children (45%) had onset before 1 year of age. The mean age at surgery was 7.9 years (range: 1-16). Daily seizures were present in 63% of children. MRI was positive in 58 cases (93.5%) and invasive stereo-EEG was judged mandatory in 24/62 (39%) of patients. Surgery was confined to the parietal lobe in 11 children, the occipital lobe in 8, the occipito-parietal region in four, the occipito-temporal region in 18, and involved both the temporal and parietal lobes in the ...
Outcomes of Disconnective Surgery in Intractable Pediatric Hemispheric and Subhemispheric Epilepsy
International Journal of Pediatrics, 2012
Objectives: To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy.Methods: A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years) who underwent a peri-insular hemispherotomy (PIH) or a peri-insular posterior quadrantectomy (PIPQ) from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engel’s classification and cognitive skills by appropriate measures of intelligence that were repeated annually.Results: There were 34 patients in all. Epilepsy was due to Rasmussen’s encephalitis (RE), Infantile hemiplegia seizure syndrome (IHSS), Hemimegalencephaly (HM), Sturge Weber syndrome (SWS) and due to post encephalitic sequelae (PES). Twenty seven (79.4%) patients underwent PIH and seven (20.6%) underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1%) were seizure free. The age of s...
Neurosurgical Focus, 2013
Object Outcomes following functional hemispherotomy in patients with drug-resistant epilepsy have been well described. However, studies reporting long-term longitudinal outcomes after subhemispheric disconnective epilepsy surgery are still limited. Methods The authors conducted a retrospective review of prospectively collected data of 10 children who underwent temporoparietooccipital (TPO) disconnective surgery at the Vienna Pediatric Epilepsy Center. Results There were 3 males and 7 females (median age 8.7 years; range 4.2–22.1 years). The affected hemisphere was the left in 3 patients and the right in 7. The patients' median age at seizure onset was 3.0 years (range 0.2–8.3 years). The median duration of epilepsy before surgery was 5.2 years (range 1.3–17.2 years). The underlying pathology was TPO malformation of cortical development in 5 patients, and venous infarction, posterior hemispheric quadrant atrophy, Sturge-Weber syndrome, cortical involvement of a systemic lupus ery...
Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2015
Infants with epilepsy often have a catastrophic course. There is a reluctance to operate in the very young, due to the perception of an unacceptable risk of morbidity with early operations. The purpose of this investigation was to better characterize the efficacy and safety of epilepsy surgery in infants. Epilepsy operations performed on children under 1 year old, between 2002 and 2013, were reviewed for demographic information, epilepsy characteristics, surgical approach, outcomes, and surgical complications. Twenty-five patients, ages 11 days to 11.5 months (mean 4.7) at operation, were identified. All had daily seizures. Twenty-two (88 %) had an abnormal magnetic resonance imaging (MRI). Sixteen (64 %) patients underwent hemispherotomy at initial operation. Seven (28 %) infants had grid placement followed by focal resection. Focal cortical dysplasia was the most common pathology (40 %) followed by hemimegalencephaly (32 %). Complications occurred in 36 % of patients. These includ...