Surgical treatment for multifocal epilepsy
DOI:
https://doi.org/10.14739/2310-1210.2022.1.239499Keywords:
epilepsy, multilobar resections, callosotomy, functional hemispherotomyAbstract
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.
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
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)