Occurrence of bilaterally independent epileptic spasms after a corpus callosotomy in West syndrome

Kobayashi, Katsuhiro; Endoh, Fumika; Toda, Yoshihiro; Oka, Makio; Baba, Hiroshi; Ohtsuka, Yoko; Yoshinaga, Harumi

doi:10.1016/j.braindev.2015.05.003

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…Intracranial EEG showed that ES originate from multiple cortical areas 4,26. Scalp EEG demonstrated ictal fast oscillations indicative of the cortical origin of ES 14,31. Our data suggested that extensive resected area showing high values of OR(FRs) and MI (FRs & 3-4 Hz) achieved seizure freedom in children with drug-resistant ES.…”

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confidence: 66%

Strong coupling between slow oscillations and wide fast ripples in children with epileptic spasms: Investigation of modulation index and occurrence rate

et al. 2018

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mentioning

confidence: 66%

Strong coupling between slow oscillations and wide fast ripples in children with epileptic spasms: Investigation of modulation index and occurrence rate

et al. 2018

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“…CC may contribute to the identification of the original epileptogenic area in WS. Furthermore, ES that were bilaterally synchronous before CC changed to bilaterally independent ES originating from the contralateral hemisphere after CC . This finding may reflect the importance of the bilateral connections through the corpus callosum for the generation of bilateral ES.…”

Section: Discussionmentioning

confidence: 87%

Surgical and developmental outcomes of corpus callosotomy for West syndrome in patients without MRI lesions

et al. 2018

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Summary Objective This retrospective study was designed to assess the impact of corpus callosotomy (CC) in patients with intractable West syndrome (WS) without lesions on magnetic resonance imaging (MRI). Methods This study involved 56 patients with WS who underwent CC between January 2000 and December 2014. Seizure outcomes and changes in psychomotor development were analyzed. Results Mean age at the onset of epilepsy and at the time of CC was 5.1 and 22.6 months, respectively. Mean duration of epilepsy before CC was 17.6 months. Video‐electroencephalography (EEG) monitoring showed bilateral ictal and interictal abnormalities before CC. Mean follow‐up duration was 36.6 months. At final follow‐up, seizure outcomes after CC were seizure‐free in 18 patients (32.1%), excellent (E: >80% reduction in seizure frequency) in 15 (26.8%), good (G: >50% reduction) in 10 (17.9%), and poor (P: <50% reduction) in 13 (23.2%). Epileptic spasms (ES) were eliminated in 24 patients (42.9%). However, tonic seizure (TS) outcomes were poor (P < 0.05). Of preoperative predictive factors related to seizure outcome, developmental delay before epilepsy onset correlated with poor outcome (P < 0.05). One year post‐CC, 6 patients (10.7%) had no epileptic abnormality on EEG, 19 (33.9%) had lateralized epileptic abnormalities, and 31 (55.4%) had bilateral asynchronous epileptic abnormalities. All patients without epileptic discharge achieved seizure freedom. Fifteen of 19 (78.9%) patients in the lateralized group and 12 of 31 (38.7%) in the bilateral asynchronous group had worthwhile outcomes (F + E). The patterns of EEG changes after CC correlated with seizure outcome (P < 0.01). Progressive declines in developmental quotient were prevented in patients with worthwhile outcomes. Significance CC represents an important therapeutic option for patients with WS without resectable MRI lesions. Transcallosal seizure bilateralization is critical for bilateral ES generation. Early identification of potential CC candidates and surgical intervention are important for better seizure control and cognitive capacity preservation before severe developmental delay development.

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“…Conversely, other authors have reported that CC may be ineffective for reducing ES 22,24 , suggesting that some forms of ES are less affected by the corpus callosum. Furthermore, in one case report, a patient with West syndrome whose ES were initially bilateral and synchronous developed bilaterally independent ES originating in either hemisphere after total CC 25 . ES are speculated to represent a heterogeneous group of seizures that derive from a peculiar age-related cortical-subcortical interaction: Vigevano et al .…”

Section: Discussionmentioning

confidence: 99%

Symmetry of ictal slow waves may predict the outcomes of corpus callosotomy for epileptic spasms

Kanai

Oguri

Okanishi

et al. 2019

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We aimed to analyse the ictal electrographic changes on scalp electroencephalography (EEG), focusing on high-voltage slow waves (HVSs) in children with epileptic spasms (ES) and tonic spasms (TS) and then identified factors associated with corpus callosotomy (CC) outcomes. We enrolled 17 patients with ES/TS who underwent CC before 20 years of age. Post-CC Engel’s classification was as follows: I in 7 patients, II in 2, III in 4, and IV in 4. Welch’s t-test was used to analyse the correlation between ictal HVSs and CC outcomes based on the following three symmetrical indices: (1) negative peak delay: interhemispheric delay between negative peaks; (2) amplitude ratio: interhemispheric ratio of amplitude values for the highest positive peaks; and (3) duration ratio: interhemispheric ratio of slow wave duration. Ages at CC ranged from 17–237 months. Four to 15 ictal EEGs were analysed for each patient. The negative peak delay, amplitude ratio and duration ratio ranged from 0–530 ms, 1.00–7.40 and 1.00–2.74, respectively. The negative peak delay, amplitude ratio and duration ratio were significantly higher in the seizure residual group (p = 0.017, <0.001, <0.001, respectively). Symmetry of ictal HVSs may predict favourable outcomes following CC for ES/TS.

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Occurrence of bilaterally independent epileptic spasms after a corpus callosotomy in West syndrome

Cited by 7 publications

References 10 publications

Strong coupling between slow oscillations and wide fast ripples in children with epileptic spasms: Investigation of modulation index and occurrence rate

Strong coupling between slow oscillations and wide fast ripples in children with epileptic spasms: Investigation of modulation index and occurrence rate

Surgical and developmental outcomes of corpus callosotomy for West syndrome in patients without MRI lesions

Symmetry of ictal slow waves may predict the outcomes of corpus callosotomy for epileptic spasms

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