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Resection Surgery in Patients with Perirolandic Epilepsy


Authors: M. Brázdil 1;  R. Kuba 1;  J. Chrastina 2;  Z. Novák 2;  J. Hemza 2;  M. Hermanová 3;  I. Tyrlíková 1;  M. Ryzí 4;  H. Ošlejšková 4;  B. Slaná 3;  M. Mikl 1;  M. Pažourková 5;  I. Rektor 1
Authors‘ workplace: Centrum pro epilepsie Brno I. neurologická klinika LF MU a FN u sv. Anny v Brně 1;  Centrum pro epilepsie Brno Neurochirurgická klinika LF MU a FN u sv. Anny v Brně 2;  Centrum pro epilepsie Brno Patologicko-anatomický ústav LF MU a FN u sv. Anny v Brně 3;  Centrum pro epilepsie Brno Klinika dětské neurologie LF MU a FN Brno 4;  Centrum pro epilepsie Brno Klinika zobrazovacích metod LF MU a FN u sv. Anny v Brně 5
Published in: Cesk Slov Neurol N 2011; 74/107(1): 43-48
Category: Original Paper

Overview

Purpose:
To assess the efficacy and safety of resective epilepsy surgery in unselected patients with both lesional and nonlesional perirolandic epilepsy.

Methods:
A group of 15 consecutive patients who had undergone perirolandic cortical resection (without multiple subpial transections) for intractable epilepsy between 1995 and 2009 was identified. This number represented 5.2% of all resective epilepsy surgeries at the Brno Epilepsy Centre. A detailed analysis was performed in 13 patients with a minimum postoperative follow-up 2 years (average 7 years). The average age at the time of surgery was 27 years (range 13–50 years). Pre-operative MRI disclosed restricted lesion in the perirolandic cortex in nine patients; in four subjects repeated and thorough neuro-imaging investigation failed to identify any structural pathology. Most patients underwent pre-operative chronic invasive video-EEG (70%). Advanced neuro-imaging (including fMRI, subtraction ictal single photon emission tomography coregistered to MRI, magnetic resonance spectroscopy, voxel-based morphometry, etc.) was progressively introduced into the pre-operative set-up and completed whenever possible.

Results:
At the last recorded follow-up, nine patients remained seizure-free – Engel class I (70%); two patients were class II (15%), and two patients class IV (15%). Postoperative neurological deficits were present in four patients (30%). In all these cases, intensive rehabilitation resulted in significant improvement, while a mild functional deficit still remained in two patients (15%).

Conclusion:
Resective epilepsy surgery is an effective and relatively safe therapeutic strategy in properly selected patients with intractable perirolandic epilepsy. This conclusion holds for both lesional and nonlesional cases.

Key words:
central region – epilepsy surgery – intractable epilepsy – focal cortical dysplasia – neuro-imaging


Sources

1. Cascino GD. Surgical treatment for extratemporal epilepsy. Curr Treat Options Neurol 2004; 6(3): 257–262.

2. Pondal-Sordo M, Diosy D, Téllez-Zenteno JF, GirvinJP, Wiebe S. Epilepsy surgery involving the sensory-motor cortex. Brain 2006; 129(12): 3307–3314.

3. Sarkis RA, Jehi LE, Bingaman WE, Najm IM. Surgical outcome following resection of rolandic focal cortical dysplasia. Epilepsy Res 2010; 90(3): 240–247.

4. Pilcher C, Meacham WR, Holbrook TJ. Partial excision of the motor cortex in treatment of jacksonian convulsions; results in 41 cases. Arch Surg 1947; 54(6): 633–643.

5. Sandok EK, Cascino GD. Surgical treatment for perirolandic lesional epilepsy. Epilepsia 1998; 39 (Suppl 4): S42–S48.

6. Brázdil M, Hadač J, Marusič P. Farmakorezistentní epilepsie. Praha: Triton 2004.

7. Engel J, Van Ness PC, Rasmussen TB, Ojemann LM. Outcome with respect to epileptic seizures. Surgical treatment of epilepsies. New York: Raven Press 1993: 609–621.

8. Palmini A, Najm I, Avanzini G, Babb T, Guerrini R, Foldvary-Schaefer N et al. Terminology and classification of the cortical dysplasias. Neurology 2004; 62 (Suppl 3): S2–S8.

9. Lehman R, Andermann F, Olivier A, Tandon PN, Quesney LF, Rasmussen TB. Seizures with onset in the sensorimotor face area: clinical patterns and results of surgical treatment in 20 patients. Epilepsia 1994; 35(6): 1117–1124.

10. Cukiert A, Buratini JA, Machado E, Sousa A, Vieira J, Forster M et al. Seizure’s outcome after cortical resections including the face and tongue rolandic areas in patients with refractory epilepsy and normal MRI submitted to subdural grids’ implantation. Arq Neuropsiquiatr 2001; 59(3B): 717–721.

11. Otsubo H, Chitoku S, Ochi A, Jay V, Rutka JT, Smith ML et al. Malignant rolandic-sylvian epilepsy in children: diagnosis, treatment, and outcomes. Neurology 2001; 57(4): 590–596.

12. Cohen-Gadol AA, Britton JW, Collignon FP, Bates LM, Cascino GD, Meyer FB. Nonlesional central lobule seizures: use of awake cortical mapping and subdural grid monitoring for resection of seizure focus. J Neurosurg 2003; 98(6): 1255–1262.

13. Brázdil M, Mikl M, Chlebus P, Pažourková M, Novák Z, Chrastina J et al. Combining advanced neuroimaging techniques in presurgical workup of non-lesional intractable epilepsy. Epileptic Disord 2006; 8(3): 190–194.

14. Preul MC, Leblanc R, Cendes F, Dubeau F, Reutens D, Spreafico R et al. Function and organization in dysgenic cortex. Case report. J Neurosurg 1997; 87(1): 113–121.

15. Vitali P, Minati L, D’Incerti L, Maccagnano E, Mavilio N, Capello D et al. Functional MRI in malformations of cortical development: activation of dysplastic tissue and functional reorganization. J Neuroimaging 2008; 18(3): 296–305.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery


2011 Issue 1

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