Comparing late‐onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post‐encephalitis/encephalopathy and non‐encephalitis/encephalopathy
Abstract Objective We aimed to analyze the efficiency of corpus callosotomy (CC) and subsequent disconnection surgeries in patients with late‐onset epileptic spasms (LOES) by comparing post‐encephalitis/encephalopathy (PE) and non‐encephalitis/encephalopathy (NE). We hypothesized these surgeries can...
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| Format: | Article |
| Language: | English |
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Wiley
2023-06-01
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| Series: | Epilepsia Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/epi4.12698 |
| _version_ | 1827935661779320832 |
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| author | Takeshi Inoue Ichiro Kuki Takehiro Uda Noritsugu Kunihiro Ryoko Umaba Saya Koh Megumi Nukui Shin Okazaki Hiroshi Otsubo |
| author_facet | Takeshi Inoue Ichiro Kuki Takehiro Uda Noritsugu Kunihiro Ryoko Umaba Saya Koh Megumi Nukui Shin Okazaki Hiroshi Otsubo |
| author_sort | Takeshi Inoue |
| collection | DOAJ |
| description | Abstract Objective We aimed to analyze the efficiency of corpus callosotomy (CC) and subsequent disconnection surgeries in patients with late‐onset epileptic spasms (LOES) by comparing post‐encephalitis/encephalopathy (PE) and non‐encephalitis/encephalopathy (NE). We hypothesized these surgeries can control potential focal onset epileptic spasms (ES) in the NE group but not in the PE group. Methods We retrospectively included 23 patients (12 with PE and 11 with NE) who initially underwent CC and subsequent disconnection surgeries (five NE). We compared the clinical courses, seizure types, MRI, video‐EEG, epilepsy surgery, and seizure outcomes between the two groups. Results The median age of LOES onset in the PE group was 2.8 (range 1.0–10.1 years) and 2.9 years (range 1.1–12.6) in the NE group. Bilateral MRI abnormalities were observed in both groups (PE, n = 12; NE, n = 3; P < 0.05). The PE group presented ES alone (n = 2), ES + focal seizures (FS) (n = 3), ES + generalized seizures (GS) (n = 3), and ES + FS + GS (n = 4) in addition to stimulus‐induced startle seizures (SS) (n = 8) (mean 3.1 seizure types/patient). The NE group presented ES alone (n = 1), ES + FS (n = 2), and ES + FS + GS (n = 8) (mean 2.7 seizure types/patient). In the PE group, CC stopped ES (n = 1) and SS (n = 1) and achieved <50% SS (n = 3). In the NE group, CC achieved immediate ES‐free status (n = 2) and < 50% ES (n = 1), and additional disconnection surgeries subsided all seizure types (n = 3) based on lateralized interictal/ictal EEG findings. LOES was significantly remitted by surgery in the NE group (6/11 [55%]) compared with the PE group (1/12 [8%]) (P < 0.05). Significance LOES is a drug‐resistant, focal/generalized/unknown onset ES. Lateralization of ES in NE could be achieved after CC and eliminated by further disconnection surgeries because of potential focal onset ES. LOES in PE had little benefit from CC for generalized onset ES. However, CC might reduce SS in patients in the PE group with multiple seizure types. |
| first_indexed | 2024-03-13T07:58:01Z |
| format | Article |
| id | doaj.art-4e5fb92ed4474f9ebbbf46d2aad7f282 |
| institution | Directory Open Access Journal |
| issn | 2470-9239 |
| language | English |
| last_indexed | 2024-03-13T07:58:01Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Epilepsia Open |
| spelling | doaj.art-4e5fb92ed4474f9ebbbf46d2aad7f2822023-06-02T03:50:17ZengWileyEpilepsia Open2470-92392023-06-018234635910.1002/epi4.12698Comparing late‐onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post‐encephalitis/encephalopathy and non‐encephalitis/encephalopathyTakeshi Inoue0Ichiro Kuki1Takehiro Uda2Noritsugu Kunihiro3Ryoko Umaba4Saya Koh5Megumi Nukui6Shin Okazaki7Hiroshi Otsubo8Department of Pediatric Neurology Osaka City General Hospital Osaka JapanDepartment of Pediatric Neurology Osaka City General Hospital Osaka JapanDepartment of Pediatric Neurosurgery Osaka City General Hospital Osaka JapanDepartment of Pediatric Neurosurgery Osaka City General Hospital Osaka JapanDepartment of Pediatric Neurosurgery Osaka City General Hospital Osaka JapanDepartment of Neurosurgery Osaka Metropolitan University Graduate School of Medicine Osaka JapanDepartment of Pediatric Neurology Osaka City General Hospital Osaka JapanDepartment of Pediatric Neurology Osaka City General Hospital Osaka JapanDivision of Neurology The Hospital for Sick Children Toronto Ontario CanadaAbstract Objective We aimed to analyze the efficiency of corpus callosotomy (CC) and subsequent disconnection surgeries in patients with late‐onset epileptic spasms (LOES) by comparing post‐encephalitis/encephalopathy (PE) and non‐encephalitis/encephalopathy (NE). We hypothesized these surgeries can control potential focal onset epileptic spasms (ES) in the NE group but not in the PE group. Methods We retrospectively included 23 patients (12 with PE and 11 with NE) who initially underwent CC and subsequent disconnection surgeries (five NE). We compared the clinical courses, seizure types, MRI, video‐EEG, epilepsy surgery, and seizure outcomes between the two groups. Results The median age of LOES onset in the PE group was 2.8 (range 1.0–10.1 years) and 2.9 years (range 1.1–12.6) in the NE group. Bilateral MRI abnormalities were observed in both groups (PE, n = 12; NE, n = 3; P < 0.05). The PE group presented ES alone (n = 2), ES + focal seizures (FS) (n = 3), ES + generalized seizures (GS) (n = 3), and ES + FS + GS (n = 4) in addition to stimulus‐induced startle seizures (SS) (n = 8) (mean 3.1 seizure types/patient). The NE group presented ES alone (n = 1), ES + FS (n = 2), and ES + FS + GS (n = 8) (mean 2.7 seizure types/patient). In the PE group, CC stopped ES (n = 1) and SS (n = 1) and achieved <50% SS (n = 3). In the NE group, CC achieved immediate ES‐free status (n = 2) and < 50% ES (n = 1), and additional disconnection surgeries subsided all seizure types (n = 3) based on lateralized interictal/ictal EEG findings. LOES was significantly remitted by surgery in the NE group (6/11 [55%]) compared with the PE group (1/12 [8%]) (P < 0.05). Significance LOES is a drug‐resistant, focal/generalized/unknown onset ES. Lateralization of ES in NE could be achieved after CC and eliminated by further disconnection surgeries because of potential focal onset ES. LOES in PE had little benefit from CC for generalized onset ES. However, CC might reduce SS in patients in the PE group with multiple seizure types.https://doi.org/10.1002/epi4.12698corpus callosotomyencephalitisencephalopathylate‐onset epileptic spasmstimulus‐induced/startle seizuresubtotal hemispherotomy |
| spellingShingle | Takeshi Inoue Ichiro Kuki Takehiro Uda Noritsugu Kunihiro Ryoko Umaba Saya Koh Megumi Nukui Shin Okazaki Hiroshi Otsubo Comparing late‐onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post‐encephalitis/encephalopathy and non‐encephalitis/encephalopathy Epilepsia Open corpus callosotomy encephalitis encephalopathy late‐onset epileptic spasm stimulus‐induced/startle seizure subtotal hemispherotomy |
| title | Comparing late‐onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post‐encephalitis/encephalopathy and non‐encephalitis/encephalopathy |
| title_full | Comparing late‐onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post‐encephalitis/encephalopathy and non‐encephalitis/encephalopathy |
| title_fullStr | Comparing late‐onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post‐encephalitis/encephalopathy and non‐encephalitis/encephalopathy |
| title_full_unstemmed | Comparing late‐onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post‐encephalitis/encephalopathy and non‐encephalitis/encephalopathy |
| title_short | Comparing late‐onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post‐encephalitis/encephalopathy and non‐encephalitis/encephalopathy |
| title_sort | comparing late onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post encephalitis encephalopathy and non encephalitis encephalopathy |
| topic | corpus callosotomy encephalitis encephalopathy late‐onset epileptic spasm stimulus‐induced/startle seizure subtotal hemispherotomy |
| url | https://doi.org/10.1002/epi4.12698 |
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