CLINICAL AND ELECTROGRAPHIC FEATURES AND POSTOPERATIVE OUTCOME OF CLUSTERING SEIZURES
Abstract number :
2.418
Submission category :
Year :
2003
Submission ID :
1801
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Hyunmi Kim, Yong D. Park, Ki Hyeong Lee, Anthony M. Murro, Jeffrey Politsky, Mark R. Lee Neurology, Medical College of Georgia, Augusta, GA; Neurosurgery, Medical College of Georgia, Augusta, GA
Children with clusters of seizures comprise a group of truly intractable epilepsy patients. In this study, we determined the clinical features and surgical treatment outcome of patients with seizures that cluster.
We retrospectively reviewed the clinical, video-EEG data and postoperative outcome on 11 children (3-18 years; mean 8.8 years) with a seizure cluster tendency. Inclusion criteria were age [ge] 2 years and more than 3 seizures within a 10 minute to 3 hour interval. Evaluation included subtraction ictal SPECT coregistration to MRI (SISCOM), positron emission tomography (PET), or magnetoencephalography (MEG). All patients received resective surgery between 1998 and 2002.
Seven patients had cortical dysplasia. Among these 7 cases, 4 cases had tuberous sclerosis and, 1 case had Aicardi syndrome and 1 case had chromosomal translocation. The seizure types were complex partial seizures (CPS) in 6 cases, epileptic spasms (ES) in 3 cases, and CPS followed by ES (CPS-ES) in 2 cases. Seizure motor patterns were hypermotor (3 patients), hypomotor (2 patients), tonic (2 patients), and atonic (1 patient). Mean complex partial seizure duration ([plusmn] SD) was 41.4 ([plusmn] 23.2) seconds. Six patients had lateralized epileptiform discharges on interictal EEG; 4 patients of these had localized epileptiform discharges. Non-lateralized ictal EEG patterns were common: diffuse desynchronization (4 patients), diffuse rhythmic delta (3 cases), no EEG change (2 cases). Epilepsy surgery locations were: frontal (3 cases), parietal (1 cases), occipital (1 cases), fronto-temporal (2 cases), temporo-parietal (1 case), temporo-parieto-occipital (2 cases) and insular cortex (1 case). In 2 cases, intracranial EEG became lateralized following complete corpus callosotomy. Cortical resections were done in 9 cases and subtotal hemispherotomy in 2 cases. Excellent postoperative seizure outcome (Engel classification I and II) were achieved in 7 and poor outcome (Class III and IV) in 4 children. The seizure outcomes were not related with seizure type, extent of ictal onset zone or pathology. All patients improved mental and behavioral functions after epilepsy surgery.
Children with seizures that cluster respond well to epilepsy surgery. This improved outcome occurs despite poor pre-operative EEG interictal and ictal seizure localization.