HEMISPHERECTOMY IN TWO CASES OF MEDICALLY REFRACTORY REFLEX EPILEPSY
Abstract number :
2.121
Submission category :
Year :
2002
Submission ID :
3224
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Jim Owens, Lori Arentz, Rebecca Schultz, Angus Wilfong. Neurology, Baylor College of Medicine, Houston, TX; Neurology, Medical College of Wisconsin, Milwaukee, WI
RATIONALE: To report two cases of medically refractory but surgically amenable reflex epilepsy improved by functional hemispherectomy. At the end of this activity the participants should be able to discuss surgical therapy for symptomatic localization-related reflex epilepsy
METHODS: Two adolescent patients with startle-induced seizures unresponsive to medical therapy underwent a standard workup with MRI, routine EEG, video EEG monitoring, Wada testing, and neuropsychological evaluation.
RESULTS: Both patients, males aged 13 and 15 at the time of surgery, had left-sided hemiplegic cerebral palsy and mild global developmental delay. One patient had a neonatal MCA stroke with early neonatal seizures and the other had an antenatal MCA stroke with infantile spasms beginning at 6 months. Both had a several year seizure-free interval then developed left hemitonic and clonic seizures. In one patient these episodes occurred in response to sudden auditory stimuli as well as spontaneously up to 10 times every night and would often secondarily generalize. No significant response was seen with carbamazepine, lamotrigine, or the vagal nerve stimulator. In the other patient they occurred almost exclusively with auditory startle and would not generalize. Carbamazepine and oxcarbazepine were used without success. Right hemispheric interictal epileptiform spikes as well as right frontocentral ictal discharges were seen in both cases. Both patients underwent a right-sided functional hemispherectomy. The first patient, who had his surgery performed in 1999, remains seizure free with only the vagal nerve stimulator. He had mild worsening of his pre-existant left hemiparesis as well as a transient impairment of short term memory. The second patient underwent surgery April, 2002 and remains seizure free on oxcarbazepine with no significant change in his motor or cognitive function.
CONCLUSIONS: Patients with symptomatic localization-related reflex epilepsy which is medically intractable may still be excellent candidates for epilepsy surgery.
[Supported by: Pediatric Division of the Baylor College of Medicine Department of Neurology]