Posterior resection for childhood lesional epilepsy: Neuropsychological evolution

Battaglia, Domenica; Chieffo, Daniela Pia Rosaria; Tamburrini, Gianpiero; Lettori, Donatella; Losito, Emma; Leo, Giuseppina; Ranalli, Domiziana; Giansanti, C; Antichi, Eleonora; Caldarelli, Massimo; Rocco, Concezio Di; Guzzetta, Andrea

doi:10.1016/j.yebeh.2011.11.014

Cited by 14 publications

(13 citation statements)

References 29 publications

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“…A factor that might have influenced the relatively partial benefit of surgery obtained in these two children of our series is represented by the evidence of controlateral interictal spikes activities in both of them, persisting after the first operation [21]. Similarly to what has been reported by other authors, earlier surgery did not seem in our experience to influence the outcome, whereas later seizure onset seemed to be related with a better neurological and cognitive prognosis [5,21,32]. According to Sarkis et al, added functional factors influencing the seizure outcome are represented by preoperative auras, postoperative ipsilateral spikes on postoperative surface EEG and early acute postoperative seizures; only 25 % of the children with one either or more than one of these factors were in Engel class I 10 years after surgery in their experience [25].…”

Section: Seizure Outcomesupporting

confidence: 79%

“…of visual information (ventral stream leading to temporal areas) and, respectively, for spatial location (where? ), numerical cognition, visual orientation, and general visuomotor integration (dorsal stream leading to parietal areas) [5].…”

Section: Neuropsychological Evaluationmentioning

confidence: 99%

“…More perplexities exist regarding the use of extraoperative subdural EEG monitoring. The main reasons that have been cited in favor of avoiding it in posterior quadrantic epilepsy patients are the following: [1] the likelihood of a multilobar epileptogenic zone, rendering it difficult to perform an adequate covering of it with grids and electrodes; [2] the anticipation that subdural EEG monitoring would similarly show widespread, nonlocalized EEG abnormalities or fail to localize seizures due to spatial sampling issues; [3] the minimal risk from TPO surgery to determine language or motor deficits, given the nature of the lesions and the degree of preexisting developmental delays; [4] the greater likelihood of seizure freedom with a multilobar procedure than with a localized resection, prompted by a subdural EEG finding; and [5] the added risks, costs, and delays associated with a protocol including extraoperative subdural EEG recordings [20]. A more uniform consent relates to the use of intraoperative cortical mapping.…”

Section: The Role Of Intraoperative Electrocorticography and Intraopementioning

confidence: 99%

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Surgery for posterior quadrantic cortical dysplasia. A review

et al. 2014

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Seizures appear most commonly in infants and rapidly progress to a catastrophic course. They are mostly represented by focal seizures and spasms. Surface interictal video-EEG is characterized by background flattening and paroxysmal discharges prevalent on the affected side but not unusually extending to the controlateral hemisphere. The last occasionally shows an independent irritative activity in spite of the absence of further visible structural abnormalities. Most of the patients have visual field or visual attention deficits at diagnosis. Resective as well as disconnective surgical procedures have been proposed for the management of this condition, none of them having shown clear advantages in terms of seizure outcome and complications. Intraoperative electrocorticography (EcoG) and sensorimotor monitoring have been successfully used to improve the localization of the epileptic focus and reduce surgical complication rates. Undistincted lesion borders, independent controlateral ictal or/and interictal EEG activity, and incomplete resections/disconnections are among the main factors that have resulted to be associated with a worse seizure outcome.

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Section: Seizure Outcomesupporting

confidence: 79%

Section: Neuropsychological Evaluationmentioning

confidence: 99%

Section: The Role Of Intraoperative Electrocorticography and Intraopementioning

confidence: 99%

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Surgery for posterior quadrantic cortical dysplasia. A review

et al. 2014

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“…Because of the varied connections of the parietal or occipital cortices with other brain regions, seizures may propagate to motor areas, sensory association cortices, or temporolimbic structures, with correspondingly different manifestations and, one might predict, different interictal deficits. Focal lesions in these areas correlate with deficits of sensory processing, particularly visual, as well as problems with numeracy and language function 22. Involvement of the occipital cortex can result in visual field deficits corresponding to the size and location of the lesion.…”

Section: Cognitive Behavioral and Psychiatric Comorbiditiesmentioning

confidence: 99%

Patient considerations in the management of focal seizures in children and adolescents

Kenney¹,

Wirrell²

2014

AHMT

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Focal epilepsy accounts for approximately one-half to two-thirds of new-onset epilepsy in children. Etiologies are diverse, and range from benign epilepsy syndromes with normal neuroimaging and almost certain remission to focal malformations of cortical development or hippocampal sclerosis with intractable seizures persisting lifelong. Other important etiologies in children include pre-, peri-, or postnatal brain injury, low-grade neoplasms, vascular lesions, and neuroimmunological disorders. Cognitive, behavioral, and psychiatric comorbidities are commonly seen and must be addressed in addition to seizure control. Given the diverse nature of focal epilepsies in children and adolescents, investigations and treatments must be individualized. First-line therapy consists of prophylactic antiepileptic drugs; however, prognosis is poor after failure of two to three drugs for lack of efficacy. Refractory cases should be referred for an epilepsy surgery workup. Dietary treatments and neurostimulation may be considered in refractory cases who are not good candidates for surgery.

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“…1 Subtle impairments in visuospatial and perceptual abilities have been reported in small samples of both genetic OLE and structural OLE. 2,3 In addition, wider deficits in intellectual functioning, attention, episodic memory, and higher-level executive skills have been reported in genetic OLE, 2 but the broader cognitive profile of structural OLE has received limited attention [3][4][5] and remains largely unknown.…”

mentioning

confidence: 99%

The cognitive profile of occipital lobe epilepsy and the selective association of left temporal lobe hypometabolism with verbal memory impairment

et al. 2014

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SUMMARYWe investigated the cognitive profile of structural occipital lobe epilepsy (OLE) and whether verbal memory impairment is selectively associated with left temporal lobe hypometabolism on [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET). Nine patients with OLE, ages 8-29 years, completed presurgical neuropsychological assessment. Composite measures were calculated for intelligence quotient (IQ), speed, attention, verbal memory, nonverbal memory, and executive functioning. In addition, the Wisconsin Card Sorting Test (WCST) was used as a specific measure of frontal lobe functioning. Presurgical FDG-PET was analyzed with statistical parametric mapping in 8 patients relative to 16 healthy volunteers. Mild impairments were evident for IQ, speed, attention, and executive functioning. Four patients demonstrated moderate or severe verbal memory impairment. Temporal lobe hypometabolism was found in seven of eight patients. Poorer verbal memory was associated with left temporal lobe hypometabolism (p = 0.002), which was stronger (p = 0.03 and p = 0.005, respectively) than the association of left temporal lobe hypometabolism with executive functioning or with performance on the WCST. OLE is associated with widespread cognitive comorbidity, suggesting cortical dysfunction beyond the occipital lobe. Verbal memory impairment is selectively associated with left temporal lobe hypometabolism in OLE, supporting a link between neuropsychological dysfunction and remote hypometabolism in focal epilepsy.

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Posterior resection for childhood lesional epilepsy: Neuropsychological evolution

Cited by 14 publications

References 29 publications

Surgery for posterior quadrantic cortical dysplasia. A review

Surgery for posterior quadrantic cortical dysplasia. A review

Patient considerations in the management of focal seizures in children and adolescents

The cognitive profile of occipital lobe epilepsy and the selective association of left temporal lobe hypometabolism with verbal memory impairment

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