Children with medically refractory epilepsy

 

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Case illustrations
Author: Howard L. Weiner, MD

Case 1

  • 16 month-old girl presents in status epilepticus, requiring sedation and intubation (pharmacologic coma)
  • EEG reveals seizures arising from left frontal lobe
  • MRI scan suggests malformation (cortical dysplasia) of brain in left frontal lobe
  • Surgery for removal of seizure focus
  • Child returns home with parents; EEG shows no seizure activity
Left frontal seizures

Left frontal seizures

Case 2

  • 3 yo boy with TS and medically-refractory seizures
  • Developmental delay/regression
  • Multi-stage surgery
  • 90% seizure reduction, improved concentration/focus/behavior/language
Tuberous Sclerosis Tuberous Sclerosis Tuberous Sclerosis

Reviewed and revised June 2004 by Howard L. Weiner, MD, FACS, FAAP, Associate Professor of Neurosurgery & Pediatrics, Division of Pediatric Neurosurgery, NYU School of Medicine

 

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Rationale for surgery
Author: Howard L. Weiner, MD

Epilepsy Surgery for Children

  • Incidence of childhood epilepsy is ~40-100/100,000; prevalence is ~ 3.9/1,000
  • ~20 % will be surgical candidates
  • Potentially thousands of children who can be helped with surgery
  • What is medically refractory epilepsy in a child?
    • Failed 2 or more AED’s at appropriate levels
    • Developmental regression or delay
    • The definition has evolved
    • “The clock is ticking”

Rationale for Surgery

  • exploit brain development and plasticity/synaptogenesis
  • impact of seizures on developing brain/ postictal and interictal effects (epileptic encephalopathy)
  • “Kindling”- stimulation of aberrant synaptic connections/additional epileptogenic foci
  • long-term consequences: deficits in learning, memory, behavior; social, economic, educational impact; low self esteem, poor academic performance, behavioral disturbances
  • combination of factors- CNS pathology, chronic seizures, AEDs

Reviewed and revised June 2004 by Howard L. Weiner, MD, FACS, FAAP, Associate Professor of Neurosurgery & Pediatrics, Division of Pediatric Neurosurgery, NYU School of Medicine

 

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