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World Neurosurg. 2018 Aug;116:268-273. doi: 10.1016/j.wneu.2018.05.182. Epub 2018 Jun 1.

Noninvasive Presurgical Data for One-Stage Leucotomy in Catastrophic Epilepsy.

Author information

1
Section of Pediatric Epilepsy, Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA; Epilepsy Center, Neurological Institute, Department of Neurology, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: jun.park@uhhospitals.org.
2
Epilepsy Center, Neurological Institute, Department of Neurology, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
3
Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
4
Department of Pathology, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
5
Department of Neurosurgery, Neurological Institute, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Abstract

BACKGROUND:

Catastrophic epilepsy results in severe neurodevelopmental delay in infants because of frequent and/or long seizures. Therefore, consideration of early epilepsy surgery is essential for neurodevelopmental outcome. Once an infant with catastrophic seizures is identified as a surgical candidate, it is important that the surgical plan be carefully defined based on detailed presurgical evidence to minimize surgical complications in this age group.

CASE DESCRIPTION:

We present 2 infants with catastrophic epilepsy, epileptic spasms, and bihemispheric electroencephalographic abnormalities who underwent one-stage disconnection surgery based on a sound hypothesis of the epileptogenic zone. Each patient underwent an extensive noninvasive presurgical investigation followed by stereotactic disconnection leucotomy in a single stage. After the 2 children were followed for 24-36 months. A seizure reduction by at least 90% (Engel class I) was achieved in both cases with subsequent improvement in neurodevelopmental progress. There were no perioperative complications. Both patients had widespread cortical dysplasia on pathologic evaluation.

CONCLUSIONS:

Careful consideration of the noninvasive presurgical workup can identify focal onset even in the presence of catastrophic epilepsy with widespread bilateral abnormalities. Single-stage lobar leucotomy for disconnection of the epileptogenic zone can lead to excellent outcome in these patients.

KEYWORDS:

Catastrophic epilepsy; Electroencephalograph (EEG); Epileptogenic zone; Leucotomy; Noninvasive presurgical; One-stage epilepsy surgery

PMID:
29864567
DOI:
10.1016/j.wneu.2018.05.182
[Indexed for MEDLINE]

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