59. Right non-dominant temporal lobe epilepsy, Wada test and cognitive outcome after surgery
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Wada test
Temporal lobectomy
Wada test
Temporal lobectomy
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Abstract Introduction Family burden (FB) in pediatric patients with drug-resistant epilepsy (DRE) is significantly higher than that in children with non-DRE. Epilepsy surgery is an established approach to treat DRE, and this study examines the impact of pediatric epilepsy surgery on FB. Methods We retrospectively analyzed data of families and pediatric patients with focal structural DRE treated with epilepsy surgery at our epilepsy center from April 2018 to November 2021. We examined the relationship between cognitive, behavioral, and epilepsy-specific data and the FB measured with the German version of the Impact on Family Scale before and after epilepsy surgery. Results The study cohort included 31 children with DRE at a mean age of 9 years at surgery (range = 0–16) and a mean epilepsy duration of 3 years (range = 0–14). Cognitive impairment correlated with FB in children with DRE prior to surgery. At the last assessment, 14.5 months (mean, range = 6–24) after epilepsy surgery, 87.2% of patients were seizure-free, FB values had decreased by 75.0%, and behavioral problems had decreased by 85,7%. Cognitive functions remained stable following epilepsy surgery. Conclusion In children with DRE, epilepsy surgery reduces FB. Given the considerable impact of families on the development and wellbeing of their children, the impact of epilepsy surgery should be communicated to affected families.
Drug Resistant Epilepsy
Pediatric epilepsy
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Summary: Purpose: To evaluate the efficacy and risk of complications of selective posterior cerebral artery (PCA) amobarbital anesthesia in memory assessment of patients with epilepsy under consideration for temporal lobe resection. Methods: Thirty‐two candidates for temporal lobectomy in whom conclusive memory assessment could not be obtained by the standard intracarotid amobarbital procedure were submitted to a selective PCA amobarbital test. A mean dose of 75 mg amobarbital was injected via microcatheter into the P2 segment of the PCA. Ten common objects were presented for naming and remembering while the anesthesia was judged efficient. After return to neurologic baseline, recall and recognition memory were assessed. Results: In all of the 32 patients, angiography and PCA anesthesia were successfully accomplished without serious adverse events. All but one of the patients remained alert and cooperative for memory testing under the anesthesia, and 28 of these patients showed adequate memory capacity of the hemisphere contralateral to the side targeted for surgery. So far, 19 patients have proceeded to surgery, and no case of global amnesia or serious, material‐specific memory impairment has resulted. Three patients failed the PCA test (fewer than 67% items correctly recognized) and were excluded from surgery, partly on the basis of the PCA test results, but also supported by an overall evaluation of all the diagnostic procedures used. Conclusions: The selective PCA amobarbital test appears justifiable when performed by interventional neuroradiologists and may significantly reduce the risk of erroneously excluding patients with epilepsy from temporal resection. Further corroboration of the safety of the procedure seems warranted.
Amobarbital
Wada test
Anterior temporal lobectomy
Temporal lobectomy
Memory disorder
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Epilepsy is a chronic repetitive paroxysmal neurological disorders that caused by abnormal discharge of neurons. Temporal lobe epilepsy is the most common type of epilepsy, and long-term spread of seizures can damage the structure and function of the brain in the wide outside of temporal lobe regions. With the continuous development of the nervous system inspection technology, application of structural and functional examinations reveals the changes of complicated structure, function and metabolism of the epilepsy network. It helps us to explore the further pathogenesis of epilepsy and improve the effectiveness of treatment. Here, we mainly review the recent advance in the changes of structure, function and metabolism of the temporal lobe epilepsy network displayed by different inspection methods.
Key words:
Temporal lobe epilepsy; Structural network; Functional network
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Refractory (planetary science)
Neuroradiology
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Patient selection for temporal lobectomy was reviewed for 23 patients with seizures that arose independently from each temporal lobe as detected by depth electroencephalography (EEG). Although neuropsychological testing, interictal EEG findings, imaging studies, and subclinical seizures were also considered, all patients offered temporal lobectomy had (1) at least 50% of the clinical seizures originating from the lobe to be resected, (2) adequate contralateral memory on testing with amobarbital, and (3) no clear evidence of an extratemporal focus. Eleven patients underwent temporal lobectomy. Pathological findings were considered positive in all nine specimens reviewed. Nine patients had no seizures, one had greater than 75% reduction in seizure frequency, and 1 had 50 to 75% reduction. Pathological features and clinical outcome were similar in the 6 patients with fewer than 80% and the 5 patients with at least 80% of seizures originating from the resected lobe. Thus, having fewer than 80% of seizures originate from one temporal lobe should not be an absolute contraindication for temporal lobectomy.
Temporal lobectomy
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Febrile convulsions
Epilepsy syndromes
Frontal lobe
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Temporal lobectomy
Entorhinal cortex
Anterior temporal lobectomy
Temporal cortex
Complex partial seizures
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Hippocampal sclerosis
Neocortex
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To investigate the quantitative electroencephalography features of different brain lobe epilepsy.The electroencephalogram data of adult patients diagnosed with epilepsy in the epilepsy clinic of the Second Affiliated Hospital of Shandong First Medical University from January 1, 2012 to December 31, 2016 were collected, 58 cases in total. They included 28 cases of frontal lobe epilepsy,12 cases of temporal lobe epilepsy, 9 cases of occipital lobe epilepsy, and 9 cases of parietal lobe epilepsy. Quantitative electroencephalography analysis technique was used to obtain the δ, θ, α1, α2, β1 and β2 power spectrum value in patients with different brain lobe epilepsy. The δ, θ, α, and β relative power spectrum value are obtained by calculation. By comparing the quantitative electroencephalography indicators of the affected side and the healthy side, the quantitative electroencephalography characteristics of epilepsy in different lobes were obtained.θ power spectrum can be increased in the discharge lead of temporal lobe epilepsy. δ and θ power spectrum, δ relative power spectrum can be increased in the discharge lead of occipital lobe epilepsy.The increase in slow wave power spectrum in QEEG can serve as an auxiliary diagnosis for temporal lobe epilepsy and occipital lobe epilepsy.
Occipital lobe
Frontal lobe
Quantitative electroencephalography
Lobe
Parietal lobe
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