Surgical treatment for multifocal epilepsy

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.1.239499

Keywords:

epilepsy, multilobar resections, callosotomy, functional hemispherotomy

Abstract

Aim. Assessment of the surgical treatment efficacy in multifocal epilepsy by a differentiated surgical approach depending on the clinical manifestations of the disease and structural and functional changes of the brain.

Materials and methods. 48 patients with multifocal epilepsy (MFE) were enrolled in the study including 37 (77 %) children and 11 (23 %) adults. Patient age ranged from 2 to 44 years (mean 12.7 years). Most patients (46 (95.8 %) cases) had daily seizures. Before the treatment, the patients used between 2 and 11 antiepileptic drugs (on average 5.1 ± 2.5) as mono- or polytherapy.

12 (25.0 %) patients underwent stereotactic callosotomy (SC), 18 (37.5 %) – microsurgical callosotomy (MC), 6 (12.5 %) – multifocal resections (MFR), 12 (25.0 %) – functional hemispherotomy (FH). Postoperative long-term follow-up ranged from 6 months to 11 years (mean 5.5 years).

Results. Multiple epileptiform focuses or diffuse structural and electric discharges within one hemisphere observed in 25 (52 %) cases; bilateral structural lesions revealed in 19 (40 %) cases; MRI-negative epilepsy with bilateral discharges – in 4 (8 %) patients.

After surgery, 23 (48 %) patients became seizures free (Engel Class IA), 8 (17 %) patients had rare short auras or focal seizures (Engel Class II), the seizure frequency reduced by less than 75 % or did not change significantly in 6 (13 %) cases. Best results were achieved after FH and MFR (90 % patients became seizures free), whereas seizures stopped only in 25 % cases after SC. 3 (6.3 %) patients developed operative complications, one of them died (postoperative mortality was 2.1 %).

Conclusions. Combination of resective and disconnection surgeries is effective and safe method of surgical treatment for MFE. Stopping seizures leads to the regression of psycho-emotional disorders in children with severe epilepsy and increases the quality of life.

Author Biographies

K. R. Kostiuk, The State Institution “Romodanov Neurosurgery Institute"National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, DSc, Chief of the Department of Functional Neurosurgery and Neuromodulation, Head Scientist

V. M. Buniakin, The State Institution “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine”, Kyiv

MD, Neurosurgeon, Graduate Student of the Department of Functional Neurosurgery and Neuromodulation

V. V. Cheburakhin, State Institution “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, Neurosurgeon of the Department of Functional Neurosurgery and Neuromodulation

M. M. Shevelov, The State Institution “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, Neurosurgeon of the Department of Functional Neurosurgery and Neuromodulation

Y. M. Medvedev, The State Institution “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, Neurosurgeon of the Department of Functional Neurosurgery and Neuromodulation

A. O. Popov, The State Institution “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine”, Kyiv

MD, Neurosurgeon of the Department of Functional Neurosurgery and Neuromodulation

D. A. Tevzadze, Shupyk National Healthcare University of Ukraine, Kyiv

MD, Neurosurgery Resident

S. M. Dichko, The State Institution “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine”, Kyiv

MD, Anesthesiologist of the Department of Functional Neurosurgery and Neuromodulation

V. V. Musulievska, Shupyk National Healthcare University of Ukraine, Kyiv

MD, Neurosurgery Resident

O. M. Kanaikin, The State Institution “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine”, Kyiv

MD, Neurophysiologist of the Department of Functional Neurosurgery and Neuromodulation

References

Engel, J., Jr. (2016). What can we do for people with drug-resistant epilepsy? The 2016 Wartenberg Lecture. Neurology, 87(23), 2483-2489. https://doi.org/10.1212/WNL.0000000000003407

Kwan, P., & Brodie, M. J. (2002). Refractory epilepsy: A progressive, intractable but preventable condition? Seizure, 11(2), 77-84. https://doi.org/10.1053/seiz.2002.0593

French, J. A., & Delanty, N. (2009). Therapeutic Strategies in Epilepsy. Clinical Publishing.

Kamada, K., Ogawa, H., Kapeller, C., Prueckl, R., Hiroshima, S., Tamura, Y., Takeuchi, F., & Guger, C. (2018). Disconnection of the pathological connectome for multifocal epilepsy surgery. Journal of Neurosurgery, 129(5), 1182-1194. https://doi.org/10.3171/2017.6.JNS17452

Löscher, W., Potschka, H., Sisodiya, S. M., & Vezzani, A. (2020). Drug Resistance in Epilepsy: Clinical Impact, Potential Mechanisms, and New Innovative Treatment Options. Pharmacological Reviews, 72(3), 606-638. https://doi.org/10.1124/pr.120.019539

Jobst, B. C. (2009). Treatment algorithms in refractory partial epilepsy. Epilepsia, 50(S8), 51-56. https://doi.org/10.1111/j.1528-1167.2009.02236.x

Kayyali, H. R., Abdelmoity, A., & Baeesa, S. (2013). The Role of Epilepsy Surgery in the Treatment of Childhood Epileptic Encephalopathy. Epileptic Encephalopathies in Children, 2013, Article 983049. https://doi.org/10.1155/2013/983049

Téllez-Zenteno, J. F., Dhar, R., & Wiebe, S. (2005). Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain, 128(Pt. 5), 1188-1198. https://doi.org/10.1093/brain/awh449

Spencer, S., & Huh, L. (2008). Outcomes of epilepsy surgery in adults and children. The Lancet Neurology, 7(6), 525-537. https://doi.org/10.1016/S1474-4422(08)70109-1

Englot, D. J., Ouyang, D., Garcia, P. A., Barbaro, N. M., & Chang, E. F. (2012). Epilepsy surgery trends in the United States, 1990-2008. Neurology, 78(16), 1200-1206. https://doi.org/10.1212/WNL.0b013e318250d7ea

Sarkis, R A., Jehi, L., Najm, I. M., Kotagal, P., & Bingaman, W. E. (2012). Seizure outcomes following multilobar epilepsy surgery. Epilepsia, 53(1), 44-50. https://doi.org/10.1111/j.1528-1167.2011.03274.x

Jobst, B. C., Darcey, T. M., Thadani, V. M., & Roberts, D. W. (2010). Brain stimulation for the treatment of epilepsy. Epilepsia, 51(S3), 88-92. https://doi.org/10.1111/j.1528-1167.2010.02618.x

Morrell, M. J., & RNS System in Epilepsy Study Group. (2011). Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology, 77(13), 1295-1304. https://doi.org/10.1212/WNL.0b013e3182302056

Bergey, G. K., Morrell, M. J., Mizrahi, E. M., Goldman, A., King-Stephens, D., Nair, D., Srinivasan, S., Jobst, B., Gross, R. E., Shields, D. C., Barkley, G., Salanova, V., Olejniczak, P., Cole, A., Cash, S. S., Noe, K., Wharen, R., Worrell, G., Murro, A. M., Edwards, J., … Seale, C. G. (2015). Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology, 84(8), 810-817. https://doi.org/10.1212/WNL.0000000000001280

Sperling, M. R., Gross, R. E., Alvarez, G. E., McKhann, G. M., Salanova, V., & Gilmore, J. (2020). Stereotactic Laser Ablation for Mesial Temporal Lobe Epilepsy: A prospective, multicenter, single-arm study. Epilepsia, 61(6), 1183-1189. https://doi.org/10.1111/epi.16529

Engel, J. (Ed.). (1993). Surgical Treatment of the Epilepsies (2nd ed.). Raven Press.

Jha, A., Oh, C., Hesdorffer, D., Diehl, B., Devore, S., Brodie, M. J., Tomson, T., Sander, J. W., Walczak, T. S., & Devinsky, O. (2021). Sudden Unexpected Death in Epilepsy: A Personalized Prediction Tool. Neurology, 96(21), e2627-e2638. https://doi.org/10.1212/WNL.0000000000011849

DeGiorgio, C. M., Curtis, A., Hertling, D., & Moseley, B. D. (2019). Sudden unexpected death in epilepsy: Risk factors, biomarkers, and prevention. Acta Neurologica Scandinavica, 139(3), 220-230. https://doi.org/10.1111/ane.13049

Pensel, M. C., Nass, R. D., Taubøll, E., Aurlien, D., & Surges, R. (2020). Prevention of sudden unexpected death in epilepsy: current status and future perspectives. Expert Review of Neurotherapeutics, 20(5), 497-508. https://doi.org/10.1080/14737175.2020.1754195

LoPinto-Khoury, C., Sperling, M. R., Skidmore, C., Nei, M., Evans, J., Sharan, A., & Mintzer, S. (2012). Surgical outcome in PET-positive, MRI-negative patients with temporal lobe epilepsy. Epilepsia, 53(2), 342-348. https://doi.org/10.1111/j.1528-1167.2011.03359.x

Szaflarski, J. P., Gloss, D., Binder, J. R., Gaillard, W. D., Golby, A. J., Holland, S. K., Ojemann, J., Spencer, D. C., Swanson, S. J., French, J. A., & Theodore, W. H. (2017). Practice guideline summary: Use of fMRI in the presurgical evaluation of patients with epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology, 88(4), 395-402. https://doi.org/10.1212/WNL.0000000000003532

Jallo, G. I., & Oğuz Çataltepe. (Eds.). (2019). Pediatric Epilepsy Surgery: Preoperative Assessment and Surgical Treatment (2nd ed.). Thieme.

Cook, S. W., Nguyen, S. T., Hu, B., Yudovin, S., Shields, W. D., Vinters, H. V., Van de Wiele, B. M., Harrison, R. E., & Mathern, G. W. (2004). Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients. Journal of Neurosurgery: Pediatrics, 100(2), 125-141. https://doi.org/10.3171/ped.2004.100.2.0125

Kwan, A., Ng, W. H., Otsubo, H., Ochi, A., Snead, O. C., 3rd, Tamber, M. S., & Rutka, J. T. (2010). Hemispherectomy for the Control of Intractable Epilepsy in Childhood: Comparison of 2 Surgical Techniques in a Single Institution. Operative Neurosurgery, 67(2), 429-436. https://doi.org/10.1227/NEU.0b013e3181f743dc

Schramm, J., Kuczaty, S., Sassen, R., Elger, C. E., & von Lehe, M. (2012). Pediatric functional hemispherectomy: outcome in 92 patients. Acta Neurochirurgica, 154(11), 2017-2028. https://doi.org/10.1007/s00701-012-1481-3

Beier, A. D., & Rutka, J. T. (2013). Hemispherectomy: historical review and recent technical advances. Neurosurgical Focus, 34(6), Article E11. https://doi.org/10.3171/2013.3.FOCUS1341

Schusse, C. M., Smith, K., & Drees, C. (2018). Outcomes after hemispherectomy in adult patients with intractable epilepsy: institutional experience and systematic review of the literature. Journal of Neurosurgery, 128(3), 853-861. https://doi.org/10.3171/2016.9.JNS151778

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Published

2022-01-26

How to Cite

1.
Kostiuk KR, Buniakin VM, Cheburakhin VV, Shevelov MM, Medvedev YM, Popov AO, Tevzadze DA, Dichko SM, Musulievska VV, Kanaikin OM. Surgical treatment for multifocal epilepsy. Zaporozhye medical journal [Internet]. 2022Jan.26 [cited 2024Apr.26];24(1):70-8. Available from: http://zmj.zsmu.edu.ua/article/view/239499

Issue

Vol. 24 No. 1 (2022)

Section

Original research

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