Drug-resistant epilepsy after treatment for childhood acute lymphocytic leukaemia: from focal epilepsy to Lennox-Gastaut syndrome

2016 ◽  
Vol 18 (4) ◽  
pp. 447-453 ◽  
Author(s):  
Karina A. González-Otárula ◽  
Blanca Mercedes Álvarez ◽  
François Dubeau
Keyword(s):  
Lymphocytic Leukaemia ◽  
Focal Epilepsy ◽  
Drug Resistant ◽  
Acute Lymphocytic Leukaemia ◽  
Drug Resistant Epilepsy

scholarly journals Chronic subthreshold cortical stimulation for adult drug-resistant focal epilepsy: safety, feasibility, and technique

2018 ◽  
Vol 129 (2) ◽  
pp. 533-543 ◽  
Author(s):  
Panagiotis Kerezoudis ◽  
Sanjeet S. Grewal ◽  
Matthew Stead ◽  
Brian Nils Lundstrom ◽  
Jeffrey W. Britton ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Cortical Stimulation ◽  
Adult Patients ◽  
Therapeutic Trial ◽  
Drug Resistant ◽  
Surgical Safety ◽  
Institutional Experience ◽  
Eloquent Cortex ◽  
Drug Resistant Epilepsy ◽  
Seizure Foci

OBJECTIVEEpilepsy surgery is effective for lesional epilepsy, but it can be associated with significant morbidity when seizures originate from eloquent cortex that is resected. Here, the objective was to describe chronic subthreshold cortical stimulation and evaluate its early surgical safety profile in adult patients with epilepsy originating from seizure foci in cortex that is not amenable to resection.METHODSAdult patients with focal drug-resistant epilepsy underwent intracranial electroencephalography monitoring for evaluation of resection. Those with seizure foci in eloquent cortex were not candidates for resection and were offered a short therapeutic trial of continuous subthreshold cortical stimulation via intracranial monitoring electrodes. After a successful trial, electrodes were explanted and permanent stimulation hardware was implanted.RESULTSTen patients (6 males) who underwent chronic subthreshold cortical stimulation between 2014 and 2016 were included. Based on radiographic imaging, intracranial pathologies included cortical dysplasia (n = 3), encephalomalacia (n = 3), cortical tubers (n = 1), Rasmussen encephalitis (n = 1), and linear migrational anomaly (n = 1). The duration of intracranial monitoring ranged from 3 to 20 days. All patients experienced an uneventful postoperative course and were discharged home with a median length of stay of 10 days. No postoperative surgical complications developed (median follow-up length 7.7 months). Seizure severity and seizure frequency improved in all patients.CONCLUSIONSThe authors’ institutional experience with this small group shows that chronic subthreshold cortical stimulation can be safely and effectively performed in appropriately selected patients without postoperative complications. Future investigation will provide further insight to recently published results regarding mechanism and efficacy of this novel and promising intervention.

scholarly journals Current approaches to neurosurgical treatment for drug-resistant focal epilepsy in adults

2018 ◽  
Vol 10 (1S) ◽  
pp. 81-88
Author(s):  
E. A. Narodova ◽  
A. A. Narodov ◽  
N. A. Shnayder ◽  
D. V. Dmitrenko ◽  
I. G. Strotskaya
Keyword(s):  
Focal Epilepsy ◽  
Rapid Development ◽  
Adult Population ◽  
Infectious Complications ◽  
High Rate ◽  
Drug Resistant ◽  
Postoperative Rehabilitation ◽  
Foreign Countries ◽  
Neurosurgical Treatment ◽  
Drug Resistant Epilepsy

The review is dedicated to the problems of current neurosurgical treatment for drug-resistant epilepsy in the adult population of Russia and foreign countries. The literature published in the period  2010–2017 was sought in Russian and foreign databases. This  review included 58 only full-text publications. The search results  have shown that despite advances in neurosurgery for drug-resistant epilepsy and the development of new surgical procedures, the  problem of this disease has not yet been fully resolved today. This is  evidenced by fairly high global prevalence rates in patients with  postoperative epilepsy resistant to antiepileptic therapy. The  literature analysis has revealed that the mean prevalence of postoperative epilepsy is 69%. This indicator may vary according  to the type of an epileptogenic structural lesion and its location in  the brain. However, despite the rapid development of epilepsy  surgery, currently there is still a low surgical activity in the treatment  of patients with drugresistant epilepsy. Of importance is  also the presence of postoperative complications, including various  infectious complications and neurological deficit. Taking into account  the high rate of postoperative epilepsy, it is concluded that it is  appropriate to develop postoperative rehabilitation methods for patients with drug-resistant epilepsy.

scholarly journals Drug-resistant focal epilepsy in children is associated with increased modal controllability of the whole brain and epileptogenic regions

2021 ◽  
Author(s):  
Kiran Seunarine ◽  
Xiaosong He ◽  
Martin Tisdall ◽  
Christopher Clark ◽  
Danielle S Bassett ◽  
...  
Keyword(s):  
Diffusion Mri ◽  
Focal Epilepsy ◽  
Brain Network ◽  
Structure And Function ◽  
Network Control ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
And Function ◽  
The Brain ◽  
Disease Understanding

Network control theory provides a framework by which neurophysiological dynamics of the brain can be modelled as a function of the structural connectome constructed from diffusion MRI. Average controllability describes the ability of a region to drive the brain to easy-to-reach neurophysiological states whilst modal controllability describes the ability of a region to drive the brain to difficult-to-reach states. In this study, we identify increases in mean average and modal controllability in children with drug-resistant epilepsy compared to healthy controls. Using simulations, we purport that these changes may be a result of increased thalamocortical connectivity. At the node level, we demonstrate decreased modal controllability in the thalamus and posterior cingulate regions. In those undergoing resective surgery, we also demonstrate increased modal controllability of the resected parcels, a finding specific to patients who were rendered seizure free following surgery. Changes in controllability are a manifestation of brain network dysfunction in epilepsy and may be a useful construct to understand the pathophysiology of this archetypical network disease. Understanding the mechanisms underlying these controllability changes may also facilitate the design of network-focussed interventions that seek to normalise network structure and function.

scholarly journals Chronic subthreshold cortical stimulation and stimulation-related EEG biomarkers for focal epilepsy

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Brian Nils Lundstrom ◽  
Jamie Van Gompel ◽  
Fatemeh Khadjevand ◽  
Greg Worrell ◽  
Matt Stead
Keyword(s):  
Spectral Power ◽  
Focal Epilepsy ◽  
Open Loop ◽  
Cortical Stimulation ◽  
Drug Resistant ◽  
Seizure Onset Zone ◽  
Interictal Eeg ◽  
Drug Resistant Epilepsy ◽  
Surrounding Areas

Abstract Brain stimulation offers an alternative to focal resection for the treatment of focal drug-resistant epilepsy. Chronic subthreshold cortical stimulation is an individualized biomarker-informed open-loop continuous electrical stimulation approach targeting the seizure onset zone and surrounding areas. Before permanent implantation, trial stimulation is performed during invasive monitoring to assess stimulation efficacy as well as to optimize stimulation location and parameters by modifying interictal EEG biomarkers. We present clinical and neurophysiological results from a retrospective analysis of 21 patients, showing a median percent reduction in seizure frequency of 100% and responder rate of 89% with a median follow-up of 27 months. About 40% of patients were free of disabling seizures for a 12-month period or longer. We find that stimulation-induced decreases in delta (1–4 Hz) power and increases in alpha and beta (8–20 Hz) power during trial stimulation correlate with improved long-term clinical outcomes. These results suggest chronic subthreshold cortical stimulation may be an effective alternative approach to treating focal drug-resistant epilepsy and that short-term stimulation-related changes in spectral power may be a useful interictal biomarker and relate to long-term clinical outcome.

scholarly journals The use of perampanel in drug-resistant focal epilepsy: its effect on sleep

2020 ◽  
Vol 12 (6) ◽  
pp. 49-53
Author(s):  
A. A. Filin ◽  
M. V. Tardov ◽  
N. L. Kunelskaya ◽  
P. N. Vlasov
Keyword(s):  
Sleep Quality ◽  
Daytime Sleepiness ◽  
Focal Epilepsy ◽  
Drug Resistant ◽  
Quality Of Sleep ◽  
Night Sleep ◽  
Nocturnal Sleep ◽  
Therapy Regimen ◽  
Drug Resistant Epilepsy

Perampanel (PER) is an antiepileptic drug (AED), the effects of which on sleep have not been studied in Russia.Objective: to assess changes in the quality of sleep, the level of daytime sleepiness, and the polysomnographic (PSG) characteristics of nocturnal sleep in patients with drug-resistant focal epilepsy when PER is incorporated into the therapy regimen as an additional AED.Patients and methods. The investigation enrolled 12 patients (4 men and 8 women) aged 21 to 49 years with drug-resistant epilepsy treated with several AEDs, who had initiated therapy with PER as an additional AED. PSG study and questioning survey were done before and 1 month after initiation of PER therapy.Results and discussion. After one month of PER therapy, there was an increase in the quality of night sleep in 5 cases and a reduction in daytime sleepiness in 6 cases. The PSG pattern was stable in 3 patients, worsened in 1, and improved in 8.Conclusion. The preliminary results suggest that PER therapy improves night sleep quality and reduces daytime sleepiness in about half of the cases, as evidenced by the improved PSG pattern in 67% of patients.

scholarly journals Drug-resistant epilepsy, early-onset hypertension and white matter lesions: a hidden paraganglioma

2019 ◽  
Vol 12 (6) ◽  
pp. e228348
Author(s):  
Katri Silvennoinen ◽  
Alison J Waghorn ◽  
Simona Balestrini ◽  
Sanjay M Sisodiya
Keyword(s):  
White Matter ◽  
Seizure Control ◽  
Focal Epilepsy ◽  
White Matter Lesions ◽  
Drug Resistant ◽  
Deep Brain Stimulator ◽  
Drug Resistant Epilepsy ◽  
Hyperintense White Matter ◽  
Deep Brain

We describe the case of a 35-year-old man with focal epilepsy since age 16. Due to a refractory course, several treatments were tried over the years, including insertion of a deep brain stimulator. At the time of his first assessment at our unit, he had recently been diagnosed with hypertension. An MR scan of brain revealed multiple T2 hyperintense white matter lesions, and evidence of previous haemorrhage in the left basal ganglia and pons. On follow-up imaging, the changes were considered to be in keeping with hypertensive arteriopathy. He was referred for further assessment of his hypertension and was found to have a para-aortic paraganglioma. This was excised 16 months after his initial presentation to us. The surgery was associated with an improvement in his seizure control. This case serves as a reminder of the need to be vigilant about the possibility of coexisting conditions in people with epilepsy.

scholarly journals P.022 Neuroimaging findings and seizure type as risk factors for adult focal drug resistant epilepsy

2016 ◽  
Vol 43 (S2) ◽  
pp. S27-S27
Author(s):  
L Hernandez-Ronquillo ◽  
P Lebony-Roy ◽  
S Buckley ◽  
J Tellez Zenteno
Keyword(s):  
Risk Factors ◽  
Focal Epilepsy ◽  
Cortical Dysplasia ◽  
Age At Diagnosis ◽  
Control Group ◽  
Drug Resistant ◽  
Inclusion Criteria ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Drug Resistant Epilepsy

Background: About 35% of patients with epilepsy may develop drug-resistant epilepsy (DRE). Identifying risk factors associated with DRE will allow us to identify earlier patients in the course of the disease. Methods: This is a case-control study nested within a cohort. Chart reviews of subjects who full fill inclusion criteria were completed. Inclusion criteria included age>18 years, focal epilepsy determined by clinical correlation and EEG. DRE was determined by ILAE criteria. Results: 149 subjects were included. Seventy had DRE (cases), and seventy-nine did not have DRE (controls). DRE group had a mean age of 41 years (SD+14.8) compared to the control group (49+17.5) (p=0.003). DRE group had a mean age at diagnosis of epilepsy of 19+15.3 compared to the control group with a mean of 33.6+21. (p=<0.001). The main risk factors identified in this study were; cortical dysplasia OR 8.67 (CI 1.04-72.3, p=0.026); mesial temporal sclerosis (MTS) (OR 2.69; CI 1.12-6.47; p=0.024); and presence of complex partial seizures (OR 2.04. Conclusions: Young age at diagnosis of focal epilepsy, diagnosis of cortical dysplasia, MTS, and presence of complex partial seizures are risk factors for DRE

scholarly journals 18f-fdg Pet/mr in Focal Epilepsy: a New Step for Improving the Detection of Epileptogenic Lesions

2021 ◽  
Author(s):  
Anthime FLAUS ◽  
Charles MELLERIO ◽  
Sebastian RODRIGO ◽  
Vincent BRULON ◽  
Vincent LEBON ◽  
...  
Keyword(s):  
Decision Making ◽  
Fdg Pet ◽  
Visual Analysis ◽  
Focal Epilepsy ◽  
Drug Resistant ◽  
Surgical Decision ◽  
Promising Tool ◽  
Drug Resistant Epilepsy ◽  
Additional Value ◽  
Surgical Decision Making

Abstract Purpose: Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established.Methods: We retrospectively compared 18F-FDG PET/MR images with those obtained by a previous 18F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 year-old) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), confidence in results, location of PET abnormalities and presence of a structural lesion on MRI. The clinical impact on surgical strategy and outcome was assessed independently.Results: The location of epilepsy was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 of them. PET alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. PET/MR was considered better performing than PET+MR in 56% of patients. The increase in sensitivity was 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 40% of patients, consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome was obtained in 13/14 patients who underwent a cortical resection.Conclusion: Hybrid PET/MR improves the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.

scholarly journals Imaging the Extent and Location of Spatiotemporally Distributed Epileptiform Sources from MEG Measurements

2021 ◽  
Author(s):  
Xiyuan Jiang ◽  
Shuai Ye ◽  
Abbas Sohrabpour ◽  
Anto Bagic ◽  
Bin He
Keyword(s):  
Focal Epilepsy ◽  
Real Data ◽  
Drug Resistant ◽  
Interictal Spikes ◽  
Source Imaging ◽  
Non Invasive ◽  
Eeg Source Imaging ◽  
Surgical Evaluation ◽  
Extended Sources ◽  
Drug Resistant Epilepsy

Non-invasive MEG/EEG source imaging provides valuable information about the epileptogenic brain areas which can be used to aid presurgical planning in focal epilepsy patients suffering from drug-resistant seizures. However, the source extent estimation for electrophysiological source imaging remains to be a challenge and is usually largely dependent on subjective choice. Our recently developed algorithm, fast spatiotemporal iteratively reweighted edge sparsity minimization (FAST-IRES) strategy, has been shown to objectively estimate extended sources from EEG recording, while it has not been applied to MEG recordings. In this work, through extensive numerical experiments and real data analysis in a group of focal drug-resistant epilepsy patients interictal spikes, we demonstrated the ability of FAST-IRES algorithm to image the location and extent of underlying epilepsy sources from MEG measurements. Our results indicate the merits of FAST-IRES in imaging the location and extent of epilepsy sources for pre-surgical evaluation from MEG measurements.

scholarly journals Successful treatment with adjunctive lacosamide in a patient with long term “drug resistant” focal epilepsy

2014 ◽  
Vol 22 (1) ◽  
pp. 51-55
Author(s):  
Walter Fröscher ◽  
Alois Rauber
Keyword(s):  
Case Report ◽  
Focal Epilepsy ◽  
Adjunctive Treatment ◽  
High Dose ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Off Label ◽  
Number Of Patients ◽  
Drug Resistant Epilepsy

SUMMARY Introduction. A significant number of patients suffering from epilepsy prove to be resistant to antiepileptic drugs (AEDs). Recent studies, however, suggest that 10–20% of seemingly drug resistant patients may still become seizure-free under the influence of subsequent dosage modifications. Case report. We report on a young man with cryptogenic focal epilepsy. He had his first seizure at the age of fifteen. His seizure frequency was decreased during the following 11 years. However, seizure-freedom was never achieved even though he was treated with twelve to fourteen different AEDs during this time. Intensive presurgical evaluations did not allow identification of a surgically remediable focus. Adjunctive treatment with lacosamide 400 mg/day was not successful. However, the patient became seizure-free immediately after an increase of the lacosamide dose up to 500 mg/day. The patient is now seizure-free for more than two years based on a combination of 500 mg lacosamide and 350 mg lamotrigine, followed by 550 mg and 250 mg, respectively. Discussion and conclusion. This case report highlights that there is always a chance that modifying the medication can result in a drug-resistant epilepsy patient experiencing a significant reduction of seizures and becoming seizure-free. The decisive step in this example was the off-label prescription of a high dose of lacosamide which the patient tolerated well.

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