2012, Number 3
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Rev Mex Neuroci 2012; 13 (3)
Evaluation of early surgical treatment in infants with catastrophic epilepsies associated with cortical dysplasias
Andrade-Bañuelos A, Jean-Tron G, Ortega-Ponce FE, Said RAST, Price A, Cortina-Ramírez M
Language: Spanish
References: 36
Page: 132-138
PDF size: 321.95 Kb.
ABSTRACT
Introduction: Cortical dysplasias (CD) can present as
catastrophic epilepsy in early infancy, which may have
a negative impact in neurological development. The
interictal electroencephalogram (EEG), usually shows
diffuse or generalized abnormalities that can
complicate surgical decisions.
Objective: The aim of
the study was to describe the EEG findings and
surgical outcome of infants with symptomatic
catastrophic epilepsy associated with cortical
dysplasia.
Methods: We retrospectively reviewed EEGs
and electronic charts of patients who had diagnosis
of cortical dysplasia and underwent epilepsy surgery
before the age of 3 years, from 2005 to 2010 in the
clinical database of the Epilepsy Comprehensive
Center, Children’s Medical Center, Dallas, Texas.
Results: We found 4/7 girls and 3 /7 boys. The seizure
onset was from 0 to 22 months (mean 18 months). The
seizure frequency was from 13 to 50 a day (mean 28).
We reviewed 24 interictal EEGs, 9/24 showed
generalized activity (37.5%) and 15/24 (62%) were
focal. We reviewed 9 ictal vEEGs 7/9 were concordant
with the lesion (77.7%). The 7 patients underwent
intraoperative electrocorticography (ECoG). In 2/7
(28%) chronic invasive monitoring was required. 3/7
(42%) had seizure recurrence, requiring functional
hemispherotomy. 6/7 (87%) are currently seizure free,
and 1/7 had a 90% seizure reduction. Postsurgically,
all patients showed improvement on neurological
development.
Conclusions: The EEG patterns in infants
with catastrophic epilepsy whose epileptogenic focus
is associated with cortical dysplasia can be misleading
and show generalized epileptiform activity. An early
and extensive presurgical evaluation is necessary for
a successful surgery associated with a positive
neurological development and seizure control
outcomes.
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