Outcome of Medical Treatment of Postsurgical Residual Seizures
Abstract number :
V.056
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2021
Submission ID :
1826422
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:54 AM
Authors :
Kenji Sugai, MD, PhD - Soleil Kawasaki Medical Center for the Handicapped/ National Center of Neurology and Psychiatry; Taisuke Otsuki, MD, PhD – Ex-Director, Neurosurgery, Natiponal Center of Neurology and Psychiatry; Takashi Saito, MD, PhD – Section Chief, Child Neurology, Natiponal Center of Neurology and Psychiatry; Eiji Nakagawa, MD, PhD – Director, Outpatient Clinic, Natiponal Center of Neurology and Psychiatry; Masayuki Sasaki, MD, PhD – Director, Child Neurology, Natiponal Center of Neurology and Psychiatry; Masaki Iwasaki, MD, PhD – Director, Neurosurgery, Natiponal Center of Neurology and Psychiatry; Ichiro Takumi, MD, PhD – Vice-Director, Neurosurgery, St. Marianna University School of Medicine
Rationale: Although epilepsy surgery is established as an effective treatment for drug-resistant epilepsy, 30-50% of patients continue to suffer from postsurgical residual seizures (PSRSz). We retrospectively studied seizure (Sz) outcomes of medical treatment of PSRSz.
Methods: Fifty-five surgical cases with PSRSz in which Sz continued after surgery or initially ceased but recurred within one year after surgery, were medically treated by the author (KS) for >1 year {1.8-20.5 (median 7.8) years}. They underwent epilepsy surgery at 0.3-24.9 (median 6.4) years and were evaluated at the last visit, aged 5.3-40.9 (median 17.8) years. They consisted of 25 cases of focal epilepsies (FLE 20, TLE 2, OLE 3), 25 cases of generalized epilepsies (Ohtahara syndrome 5, West syndrome 2, Lennox-Gastaut syndrome 10, other SGE 8), and 5 cases of others. Their underlying conditions included developmental lesions in 25 (FCD 17, hemimegalencephaly 5, pachygyria 1, schizencephaly 1, hypothalamic hamartoma 1), postnatal insults in 9 (encephalitis 5, ulegyria 2, hemorrhage 1, infarction 1), MRI-negative West syndrome in 7, and no notable causes in 14 cases. Surgical procedures included hemispherotomy in 8, focal cortical resection in 15, corpus callosotomy in 26, and callosotomy followed by focal resection in 6 cases. Medications were selected based on Sz types. PSRSz outcome was evaluated by Sz frequency during one year before the last visit and classified into 5 categories: free (F), yearly (Y), monthly (M), weekly (W) and daily (D).
Results: PSRSz at the last evaluation were seen D in 27, W in 20 and M in 8 cases. With medical treatment, D PSRSz resulted in F in 5, M in 2, W in 10 and D in10 cases, W PSRSz turned to F in 8, Yin 5, M in 5 and W in 2 cases, and M PSRSz became F in 7 and Y in 1 case. PSRSz in focal epilepsies (D 7, W 14, M 4) resulted in F 10, Y 4, M 6, W 3 and D 2 cases; PSRSz in generalized epilepsies (D 18, W 3, M 4) turned to F 7, Y 1, M 1, W 8 and D 8 cases; PSRSz in others (D 2, W 3) became F 3, Y 1 and W 1 case. PSRSz after hemispherotomy were D in 6, W in 1 and M in 1 case, which resulted in F in 2, Y in 1, W in 2 and D in 3 cases; PSRSz after focal resection were D in 3, W in 8, M in 4 cases, which turned to F in 7, Y in 3, M in 3 and W in 2 cases; PSRSz after callosotomy were D in 14, W in 9 and M in 3 cases, which became F in 10, Y in 2, M in 2, W in 4 and D in 8 cases; PSRSz after callosotomy+focal resection were D in 4 and W in 2 case, which showed F in 1, M in 2 and W in 3 cases. Seventeen cases had single Sz type, 36 cases had two Sz types and 2 cases had three Sz types. Cumulatively, tonic Sz were seen in 41, focal to bilateral tonic-clonic (FBTCS) in 15, spasm in 10, focal impaired awareness (FIAS) in 8, atonic in 7, drop attack in 6, and others in 8 cases. Medical treatment led these cases to F in 31, Y in 11, M in13, W in 20 and D in 20 cases. M to D Sz became F to W in 31/41 tonic Sz, 13/15 FBTCS, 6/10 spasms, 8/8 FIAS , 6/7 atonic Sz and 3/6 drop attacks cases.
Conclusions: PSRSz can be controlled or reduced by pharmacotherapy. Epilepsy surgery helps medical treatment as well as provides direct effect.
Funding: Please list any funding that was received in support of this abstract.: None.
Clinical Epilepsy