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...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-07-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.922778/full |
| _version_ | 1811288878099726336 |
|---|---|
| author | Shuang Wang Shuang Wang Chang Liu Hongwei Zhang Qingzhu Liu Taoyun Ji Taoyun Ji Ying Zhu Yan Fan Hao Yu Guojing Yu Wen Wang Dongming Wang Lixin Cai Xiaoyan Liu Xiaoyan Liu |
| author_facet | Shuang Wang Shuang Wang Chang Liu Hongwei Zhang Qingzhu Liu Taoyun Ji Taoyun Ji Ying Zhu Yan Fan Hao Yu Guojing Yu Wen Wang Dongming Wang Lixin Cai Xiaoyan Liu Xiaoyan Liu |
| author_sort | Shuang Wang |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-13T03:45:09Z |
| format | Article |
| id | doaj.art-d67323362ff944c1bd23d5133d96439d |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-13T03:45:09Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-d67323362ff944c1bd23d5133d96439d2022-12-22T03:04:03ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-07-011310.3389/fneur.2022.922778922778Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative OutcomesShuang Wang0Shuang Wang1Chang Liu2Hongwei Zhang3Qingzhu Liu4Taoyun Ji5Taoyun Ji6Ying Zhu7Yan Fan8Hao Yu9Guojing Yu10Wen Wang11Dongming Wang12Lixin Cai13Xiaoyan Liu14Xiaoyan Liu15Pediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaDepartment of Pediatrics, Peking University First Hospital, Beijing, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaDepartment of Neurology, Qilu Children's Hospital of Shandong University, Shandong, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaDepartment of Pediatrics, Peking University First Hospital, Beijing, ChinaDepartment of Radiology, Peking University First Hospital, Beijing, ChinaDepartment of Nuclear Medicine, Peking University First Hospital, Beijing, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaPediatric Epilepsy Center, Peking University First Hospital, Beijing, ChinaDepartment of Pediatrics, Peking University First Hospital, Beijing, ChinaTo 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.https://www.frontiersin.org/articles/10.3389/fneur.2022.922778/fullepileptic spasmsemiologyEEGimagingepilepsy surgery |
| spellingShingle | Shuang Wang Shuang Wang Chang Liu Hongwei Zhang Qingzhu Liu Taoyun Ji Taoyun Ji Ying Zhu Yan Fan Hao Yu Guojing Yu Wen Wang Dongming Wang Lixin Cai Xiaoyan Liu Xiaoyan Liu Lesional Intractable Epileptic Spasms in Children: Electroclinical Localization and Postoperative Outcomes Frontiers in Neurology epileptic spasm semiology EEG imaging epilepsy surgery |
| 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 | epileptic spasm semiology EEG imaging epilepsy surgery |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.922778/full |
| work_keys_str_mv | AT shuangwang lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT shuangwang lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT changliu lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT hongweizhang lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT qingzhuliu lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT taoyunji lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT taoyunji lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT yingzhu lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT yanfan lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT haoyu lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT guojingyu lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT wenwang lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT dongmingwang lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT lixincai lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT xiaoyanliu lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes AT xiaoyanliu lesionalintractableepilepticspasmsinchildrenelectroclinicallocalizationandpostoperativeoutcomes |