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Surgery for Intractable Epilepsy of Infantile Onset
Author(s) -
Otsuki Taisuke,
Asano Eishi,
Ito Kenji,
Takahashi Hirotatsu,
Fukatsu Reiko,
Nagano Chiyoko,
Yoshimoto Takashi
Publication year - 1998
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1157.1998.tb01923.x
Subject(s) - cortical dysplasia , epilepsy , ganglioglioma , medicine , hemimegalencephaly , surgery , tuberous sclerosis , corpus callosotomy , temporal lobe , pediatrics , epilepsy surgery , radiology , psychiatry
Purpose : The clinical features and surgical outcome were analyzed in 11 consecutive cases of intractable epilepsy, the onset of which was within 12 months after birth. Case Reports : The onset of epilepsy in the 11 patients, seven boys and four girls, was from day 0 to 3 months old in three cases, 3 to 6 months old in five cases, and 6 to 12 months old in three cases. The types of seizure at onset were nodding spasms in four cases, tonic seizures in five, motionless staring in three, and automatisms in two. Six cases showed temporary remission of seizures for 8 months to 16 years (mean, 5.8 years) and recurrence at ages from 1 to 19 years old (mean, 8.1 years). Five patients were initially diagnosed as having West syndrome and treated with adrenocorticotropic hormone (ACTH), which resulted in temporary remission of seizures in four cases. Surgery was performed at ages from 4 weeks to 23 years (mean, 12.2 years). The types of seizures at the time of surgery were nodding spasms in one case, falling spells in three, tonic seizures in six, motionless staring in four, and automatisms in five. The pathological causes of the epilepsy were focal cortical dysplasia in five cases, tuberous sclerosis in two, hemimegalencephaly in two, ganglioglioma in one, and an unknown cause in one. The surgical methods were cortical resection in seven cases (temporal lobe in five and frontotemporal lobe in two), callosotomy in three, and hemispherotomy in one. The preoperative neuropsychological examination showed a moderate developmental delay in five cases, a slight delay in four, and normal development in one. The surgical outcome of the cortical resection was complete cessation of seizures in five cases, rare seizures in one, and a 50% improvement in one. A significant improvement in falling spells was observed in all three cases of callosotomy. Hemispherotomy resulted in cessation of seizures. Significant postoperative improvements in neuropsychological evaluation and development were observed in eight cases. Conclusions : Surgical intervention in cases of intractable epilepsy of infantile onset, especially in patients with focal cortical dysplasia, resulted in a good outcome for both seizure remission and postoperative neuropsychological development.