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Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes

To analyze the influence of seizure semiology, electroencephalography (EEG) features and magnetic resonance imaging (MRI) change on epileptogenic zone localization and surgical prognosis in children with epileptic spasm (ES) were assessed. Data from 127 patients with medically intractable epilepsy w...

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Autores principales: Wang, Shuang, Liu, Chang, Zhang, Hongwei, Liu, Qingzhu, Ji, Taoyun, Zhu, Ying, Fan, Yan, Yu, Hao, Yu, Guojing, Wang, Wen, Wang, Dongming, Cai, Lixin, Liu, Xiaoyan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353030/
https://www.ncbi.nlm.nih.gov/pubmed/35937064
http://dx.doi.org/10.3389/fneur.2022.922778
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author Wang, Shuang
Liu, Chang
Zhang, Hongwei
Liu, Qingzhu
Ji, Taoyun
Zhu, Ying
Fan, Yan
Yu, Hao
Yu, Guojing
Wang, Wen
Wang, Dongming
Cai, Lixin
Liu, Xiaoyan
author_facet Wang, Shuang
Liu, Chang
Zhang, Hongwei
Liu, Qingzhu
Ji, Taoyun
Zhu, Ying
Fan, Yan
Yu, Hao
Yu, Guojing
Wang, Wen
Wang, Dongming
Cai, Lixin
Liu, Xiaoyan
author_sort Wang, Shuang
collection PubMed
description To analyze the influence of seizure semiology, electroencephalography (EEG) features and magnetic resonance imaging (MRI) change on epileptogenic zone localization and surgical prognosis in children with epileptic spasm (ES) were assessed. Data from 127 patients with medically intractable epilepsy with ES who underwent surgical treatment were retrospectively analyzed. ES semiology was classified as non-lateralized, bilateral asymmetric, and focal. Interictal epileptiform discharges were divided into diffusive or multifocal, unilateral, and focal. MRI results showed visible local lesions for all patients, while the anatomo-electrical-clinical value of localization of the epileptogenic zone was dependent on the surgical outcome. During preoperative video EEG monitoring, among all 127 cases, 53 cases (41.7%) had ES only, 46 (36.2%) had ES and focal seizures, 17 (13.4%) had ES and generalized seizures, and 11 (8.7%) had ES with focal and generalized seizures. Notably, 35 (27.6%) and 92 cases (72.4%) showed simple and complex ES, respectively. Interictal EEG showed that 22 cases (17.3%) had bilateral multifocal discharges or hypsarrhythmia, 25 (19.7%) had unilateral dominant discharges, and 80 (63.0%) had definite focal or regional discharges. Ictal discharges were generalized/bilateral in 71 cases (55.9%) and definite/lateralized in 56 cases (44.1%). Surgically resected lesions were in the hemisphere (28.3%), frontal lobe (24.4%), temporal lobe (16.5%), temporo-parieto-occipital region (14.2%), and posterior cortex region (8.7%). Seizure-free rates at 1 and 4 years postoperatively were 81.8 and 72.7%, respectively. There was no significant difference between electroclinical characteristics of ES and seizure-free rate. Surgical treatment showed good outcomes in most patients in this cohort. Semiology and ictal EEG change of ES had no effect on localization, while focal or lateralized epileptiform discharges of interictal EEG may affect lateralization and localization. Complete resection of epileptogenic lesions identified via MRI was the only factor associated with a positive surgical outcome.
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spelling pubmed-93530302022-08-06 Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes Wang, Shuang Liu, Chang Zhang, Hongwei Liu, Qingzhu Ji, Taoyun Zhu, Ying Fan, Yan Yu, Hao Yu, Guojing Wang, Wen Wang, Dongming Cai, Lixin Liu, Xiaoyan Front Neurol Neurology To analyze the influence of seizure semiology, electroencephalography (EEG) features and magnetic resonance imaging (MRI) change on epileptogenic zone localization and surgical prognosis in children with epileptic spasm (ES) were assessed. Data from 127 patients with medically intractable epilepsy with ES who underwent surgical treatment were retrospectively analyzed. ES semiology was classified as non-lateralized, bilateral asymmetric, and focal. Interictal epileptiform discharges were divided into diffusive or multifocal, unilateral, and focal. MRI results showed visible local lesions for all patients, while the anatomo-electrical-clinical value of localization of the epileptogenic zone was dependent on the surgical outcome. During preoperative video EEG monitoring, among all 127 cases, 53 cases (41.7%) had ES only, 46 (36.2%) had ES and focal seizures, 17 (13.4%) had ES and generalized seizures, and 11 (8.7%) had ES with focal and generalized seizures. Notably, 35 (27.6%) and 92 cases (72.4%) showed simple and complex ES, respectively. Interictal EEG showed that 22 cases (17.3%) had bilateral multifocal discharges or hypsarrhythmia, 25 (19.7%) had unilateral dominant discharges, and 80 (63.0%) had definite focal or regional discharges. Ictal discharges were generalized/bilateral in 71 cases (55.9%) and definite/lateralized in 56 cases (44.1%). Surgically resected lesions were in the hemisphere (28.3%), frontal lobe (24.4%), temporal lobe (16.5%), temporo-parieto-occipital region (14.2%), and posterior cortex region (8.7%). Seizure-free rates at 1 and 4 years postoperatively were 81.8 and 72.7%, respectively. There was no significant difference between electroclinical characteristics of ES and seizure-free rate. Surgical treatment showed good outcomes in most patients in this cohort. Semiology and ictal EEG change of ES had no effect on localization, while focal or lateralized epileptiform discharges of interictal EEG may affect lateralization and localization. Complete resection of epileptogenic lesions identified via MRI was the only factor associated with a positive surgical outcome. Frontiers Media S.A. 2022-07-22 /pmc/articles/PMC9353030/ /pubmed/35937064 http://dx.doi.org/10.3389/fneur.2022.922778 Text en Copyright © 2022 Wang, Liu, Zhang, Liu, Ji, Zhu, Fan, Yu, Yu, Wang, Wang, Cai and Liu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Wang, Shuang
Liu, Chang
Zhang, Hongwei
Liu, Qingzhu
Ji, Taoyun
Zhu, Ying
Fan, Yan
Yu, Hao
Yu, Guojing
Wang, Wen
Wang, Dongming
Cai, Lixin
Liu, Xiaoyan
Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes
title Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes
title_full Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes
title_fullStr Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes
title_full_unstemmed Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes
title_short Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes
title_sort lesional intractable epileptic spasms in children: electroclinical localization and postoperative outcomes
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353030/
https://www.ncbi.nlm.nih.gov/pubmed/35937064
http://dx.doi.org/10.3389/fneur.2022.922778
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