Postoperative Seizure Control and Antiepileptic Drug Use in Pediatric Epilepsy Surgery Patients: The UCLA Experience, 1986–1997

Mathern, Gary W.; Giza, Christopher C.; Yudovin, Sue; Vinters, Harry V.; Peacock, Warwick J.; Shewmon, D. Alan; Shields, W. Donald

doi:10.1111/j.1528-1157.1999.tb01592.x

Cited by 152 publications

(111 citation statements)

References 44 publications

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“…Advocates for very early surgery point out that there is relatively low surgical morbidity, that outcome is better when the surgery is done as early as possible, and that devastating consequences of some refractory epilepsy syndromes in children may be avoided with early surgery (21,22,73,(81)(82)(83). However, the inherent risks associated with surgery mandate that medical therapy be tried first for a period of time.…”

Section: Can "Progressive Epilepsy" Be Halted?mentioning

confidence: 99%

Is Refractory Epilepsy Preventable?

et al. 2002

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Summary: About a third of the patients diagnosed with epilepsy will not be fully controlled with antiepileptic drugs (AEDs), and many of them will have frequent and disabling seizures. These patients will undergo multiple drug trials, most often without complete seizure remission. Moreover, refractory epilepsy is associated with increased morbidity (from seizures and medications), social isolation, unemployment, and overall reduced quality of life. There is evidence that refractory epilepsy can be a progressive disorder, which, if controlled early, might never develop into a full syndrome with all of its associated sequelae. The difficulty lies in identifying at an early stage patients who are likely to progress to intractability. No currently known markers enable clinicians to make this identification with confidence. Advances in pharmacogenomics and our understanding of pharmacologic responsiveness in epilepsy may change this situation. Even now, we are able to identify many patients with a poor prognosis earlier than before, particularly in the pediatric population, in which syndromic classification may provide an approach to predict intractability. The early initiation of aggressive therapy may improve outcome and overall quality of life.

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Section: Can "Progressive Epilepsy" Be Halted?mentioning

confidence: 99%

Is Refractory Epilepsy Preventable?

et al. 2002

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“…Most of them have FCD in the frontal lobe. As mentioned by other authors [5,6,22,26], FCD is associated with a wide range of clinical presentations. There is no particular seizure semiology that characterizes patients with FCD compared with other surgical series of epilepsy patients [16][17][18].…”

Section: Discussionmentioning

confidence: 98%

“…Most published series of patients are surgical or pathological series of pediatric cases [17,[22][23][24][25][26]. Patients have a high frequency of seizure, including several in the day.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of a Series of Non-Surgical Patients with Focal Cortical Dysplasia and Epilepsy

Seifer¹

2014

AJPN

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Abstract:Most published series of patients with focal cortical dysplasia and epilepsy are surgical or pathological series of pediatric cases. Patients have a high frequency of seizure. The description of clinical features and the frequency patterns of non-surgical adult patients are less describe. We retrospectively reviewed the clinical records of adult patients (>18 years of age) that visited the Epilepsy Centre of the Ramos Mejía Hospital in the city of Buenos Aires between 2010 and 2012. We included all cases with confirmed diagnosis of epilepsy and MRI diagnosis of focal cortical dysplasia by standardized 1.5 T MRI. We analyzed the following variables: sex, age at seizure onset, seizure types, seizure frequency, presence of abnormal neurological exam, family history of epilepsy, existence of perinatal insults and electroencephalography or video-EEG with at least one ictal recording. We included 20 patients since 2010-2012. Mean age of our population was 25.9 years (9-46 years), 7 females, 13 males, they all had a negative family history of epilepsy, and only two patients had pathological neurological exam, both with mild contralateral paresis. Mean seizure onset age was 5.71 years (2 months-17 years) and the average frequency was 5.1 seizures per month (0-15). Two patients became seizure-free after adjusting antiepileptic drugs. Focal seizures were presented in the 100% of our population. The low frequency of seizure emphasizes the heterogeneity of these patients and the importance of the correct use of antiepileptic drugs schemes, as well as it can be dynamic over time. A proportion of medically resistant patients with cortical dysplasia are poor surgical candidates because the lesion cannot be completely identify or removed if it involves eloquent areas of the cortex. With the development of new drugs and the correct choice of treatment schedules is expected that more patients with focal cortical dysplasia would be treated successfully.

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“…Extratemporal and multilobar cortical resections for intractable epilepsy are much more common in pediatric patients compared with adult patients. 9,12) In some cases of medically intractable pediatric epilepsy, the extent of the underlying cortical abnormality requires hemispherectomy 14) ; however, in others, the epileptogenic focus is more limited, involving one or more lobes of one hemisphere. The pathological profile in the cases presented here involved malformations of cortical development, and all patients were diagnosed with catastrophic epilepsy, characterized by seizure onset within 2 weeks of birth and high frequency of seizures (10-40/day).…”

Section: Discussionmentioning

confidence: 99%

Posterior Disconnection in Early Infancy to Treat Intractable Epilepsy With Multilobar Cortical Dysplasia

Liang

Otsuki

Takahashi

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Extensive multilobar cortical dysplasias occasionally occur in children and can induce seizure onset in early infancy, causing severe epileptic encephalopathy. Surgical interventions in early infancy, such as disconnection of large parts of the brain, are challenging because of the degree of invasiveness and carry greater risks in infants compared with older children. Here we report the successful treatment of intractable epilepsy with multilobar cortical dysplasias in the posterior cortex by posterior disconnection in three infants (age 3 months). The patients showed good postoperative recovery and exhibited excellent seizure control at follow-up evaluation within a year after surgery. Developmental catch-up was also achieved and no early complications have been detected to date. Use of the posterior disconnection technique for early-stage extensive multilobar cortical dysplasias can result in good seizure control and developmental progress with little perioperative morbidity. However, the efficacy of this surgical technique needs to be verified with long-term follow up after surgery.

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Postoperative Seizure Control and Antiepileptic Drug Use in Pediatric Epilepsy Surgery Patients: The UCLA Experience, 1986–1997

Cited by 152 publications

References 44 publications

Is Refractory Epilepsy Preventable?

Is Refractory Epilepsy Preventable?

Clinical Features of a Series of Non-Surgical Patients with Focal Cortical Dysplasia and Epilepsy

Posterior Disconnection in Early Infancy to Treat Intractable Epilepsy With Multilobar Cortical Dysplasia

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