COMBINED PERI-ROLANDIC MULTIPLE SUBPIAL TRANSECTIONS (MST) AND IMMUNOLOGIC TREATMENT (IT) STRATEGIES IN NON-HEMISPHERECTOMY (HFX) CANDIDATES WITH LATE-ONSET RASMUSSEN[scquote]S ENCEPHALITIS (RAS)
Abstract number :
3.279
Submission category :
Year :
2002
Submission ID :
2542
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Victor Martinez, Andre Palmini, Eliseu Paglioli-Neto, Jaderson Costa da Costa, Marcio Bezerra, Luis Athayde-Jr., Mara-Lucia S. Ferreira, Mirna Portuguez, Eduardo Paglioli, Ligia Coutinho, Sergio Raupp, Jo[atilde]o-Rubi[atilde]o Hoefel-Filho, Fabiana Mugno
RATIONALE: Patients with Ras are usually candidates for functional HFx, unless the disorder starts during adolescence, when brain plasticity is less reliable. Therapeutic alternatives for such patients are not fully defined.
We herein report the value of peri-rolandic MST associated or not with IT for patients with adolescent-onset Ras.
METHODS: We have evaluated 3 patients with adolescent-onset Ras (1 right, 2 left hemisphere) who had refractory partial motor and secondarily generalized seizures, as well as prolonged bouts of epilepsia partialis continua or negative myoclonus. Seizures led to prolonged or recurrent ICU admissions in all. Motor and language functions were largely preserved, mitigating against HFx. Peri-rolandic MST coupled with IT (IV methylprednisolone, IVIg, and/or ganciclovir) was the chosen therapeutic strategy in all.
RESULTS: All patients have stabilized their motor function, and only sporadic seizures have remained, after 3, 4, and 5 years of follow up, respectively. Remarkably, there were no further ICU admissions for staus epilepticus or epilepsia partialis continua. Only one patient still receives ganciclovir and methylprednisolone every six months. However, all three take maximum tolerated dosages of 2 or more antiepileptic drugs.
CONCLUSIONS: Peri-rolandic MST coupled with IT is well tolerated and may prove to be a most valuable alternative for non-HFx candidates with late-onset Ras.
[Supported by: FAPERGS]