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Epilepsy control following intracranial monitoring without resection in young children. Epilepsia 2012 Feb;53(2):334-41

Date

01/17/2012

Pubmed ID

22242686

DOI

10.1111/j.1528-1167.2011.03380.x

Scopus ID

2-s2.0-84856351624   16 Citations

Abstract

PURPOSE: Intracranial monitoring (IM) is a key diagnostic procedure for select patients with treatment-resistant epilepsy (TRE). Seizure focus resection may improve seizure control in both lesional and nonlesional TRE. IM itself is not considered to have therapeutic potential. We describe a cohort of patients with improved seizure control following IM without resective surgery.

METHODS: Over 12.5 years, 161 children underwent 496 surgeries including intracranial monitoring. We retrospectively reviewed the patients' charts, operative reports, and radiologic scans, under an institutional review board-approved protocol.

KEY FINDINGS: Seventeen patients underwent only IM, without additional resective surgery, and seven had a dramatic improvement in their epilepsy; six of the seven patients are seizure-free (Engel class I), and one rarely has seizures (Engel class II). All seven patients had frequent seizures that led to IM: either daily (five patients) or 1-2 per week (two patients). The mean age (A? standard deviation, SD) at seizure onset was 1.6 A? 1.3 years (range 0.5-4 years). Etiologies were tuberous sclerosis (3 patients), trauma (1 patient), and unknown (3 patients). Mean age at surgery (A? SD) was 4.1 A? 2 years (range 1-7 years), and duration of epilepsy 2.5 A? 1.1 years (range 0.5-4 years). Duration of IM was 11.7 A? 5.6 days (5-19 days). Six patients had bilateral and one unilateral invasive electrodes. At last follow-up, four patients required fewer antiepileptic drugs (AEDs), one had the same medication but a higher dose, and two patients were taking additional AEDs. Follow-up was 30.6 A? 9.5 months (range 19-41 months).

SIGNIFICANCE: Although uncommon, patients with TRE may improve after IM alone. The explanation for this observation remains unclear; however, perioperative medications including steroids, direct cortical manipulation, or other factors may influence the epileptogenic network.

Author List

Roth J, Olasunkanmi A, Ma TS, Carlson C, Devinsky O, Harter DH, Weiner HL

Author

Chad Carlson MD Professor in the Neurology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Age of Onset
Child
Child, Preschool
Craniotomy
Electric Stimulation Therapy
Electrodes, Implanted
Electroencephalography
Epilepsy
Female
Humans
Infant
Male
Monitoring, Physiologic
Retrospective Studies