RESUMO
OBJECTIVE: In the presurgical evaluation of patients with drug-resistant epilepsy (DRE), occasionally, patients do not experience spontaneous typical seizures (STS) during a stereo-electroencephalography (SEEG) study, which limits its effectiveness. We sought to identify risk factors for patients who did not have STS during SEEG and to analyze the clinical outcomes for this particular set of patients. METHODS: We conducted a retrospective analysis of all patients with DRE who underwent depth electrode implantation and SEEG recordings between January 2013 and December 2018. RESULTS: SEEG was performed in 155 cases during this period. 11 (7.2%) did not experience any clinical seizures (non-STS group), while 143 experienced at least one patient-typical seizure during admission (STS group). No significant differences were found between STS and non-STS groups in terms of patient demographics, lesional/non-lesional epilepsy ratio, pre-SEEG seizure frequency, number of ASMs used, electrographic seizures or postoperative seizure outcome in those who underwent resective surgery. Statistically significant differences were found in the average number of electrodes implanted (7.0 in the non-STS group vs. 10.2 in STS), days in Epilepsy Monitoring Unit (21.8 vs. 12.8 days) and the number of cases that underwent resective surgery following SEEG (27.3% vs. 60.8%), respectively. The three non-STS patients (30%) who underwent surgery, all had their typical seizures triggered during ECS studies. Three cases were found to have psychogenic non-epileptic seizures. None of the patients in the non-STS group were offered neurostimulation devices. Five of the non-STS patients experienced transient seizure improvement following SEEG. SIGNIFICANCE: We were unable to identify any factors that predicted lack of seizures during SEEG recordings. Resective surgery was only offered in cases where ECS studies replicated patient-typical seizures. Larger datasets are required to be able to identify factors that predict which patients will fail to develop seizures during SEEG.
Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Eletrodos Implantados/efeitos adversos , Convulsões/diagnóstico , Convulsões/cirurgia , Eletroencefalografia , Epilepsia/cirurgia , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/cirurgia , Técnicas EstereotáxicasRESUMO
OBJECTIVE: Epilepsy surgery for older adults is controversial owing to their longer duration of epilepsy and perceived higher surgical risk. However, because of an aging population and documented benefit of epilepsy surgery, surgery is considered more frequently for these patients. The authors' objective was to analyze the role of resective surgery in patients older than 60 years and to assess outcomes and safety. METHODS: The authors conducted a retrospective analysis of 595 patients who underwent resective epilepsy surgery at their center from 1999 to 2018. Thirty-one patients aged 60 years or older were identified. Sixty patients younger than 60 years were randomly selected as controls. Population characteristics, results of presurgical evaluations, outcomes, and complications were analyzed. RESULTS: No significant differences were found between the groups in terms of hemisphere dominance, side of surgery, presence of a lesion, and incidence of temporal lobe epilepsy. Epilepsy duration was greater in the older cohort (p = 0.019), and invasive EEG was more commonly employed in younger patients (p = 0.030). The rates of Engel class I outcome at 6 months, 1 year, and 2 years were 89.7%, 96.2%, and 94.7% for the older group and 75% (p = 0.159), 67.3% (p = 0.004), and 75.8% (p = 0.130) for the younger group, respectively. The proportion of seizure-free patients was greatest among those with temporal lobe epilepsy, particularly in the older group. Neurological complication rates did not differ significantly between groups, however medical and other minor complications occurred more frequently in the older group. CONCLUSIONS: Patients older than 60 years had equal or better outcomes at 1 year after epilepsy surgery than younger patients. A trend toward a greater proportion of patients with lesional temporal lobe epilepsy was found in the older group. These results suggest that good seizure outcomes can be obtained in older patients despite longer duration of epilepsy.
RESUMO
Objetivo: conocer la anatomía de los senos de la duramadre, especialmente del seno sagital superior (SSS) y sus relaciones con las estructuras lindantes. Material y método: se utilizaron 39 encéfalos inyectados y formalizados, disecándose con técnicas microscópicas y con lupas de 2.5X el seno sagital superior y estructuras lindantes comparándose los resultados con angiografías normales. Resultados: la longitud del SSS osciló entre 20-27 cm (media 23.58 cm). Observamos que el tercio medio mayormente se desplaza a derecha, siendo 100% concordante con la sutura sagital a nivel de su desembocadura distal. En 28 casos (71.8%) había comunicación con el seno sagital inferior, conformando plexos venosos. Las lagunas se posicionaron en forma variable, ubicándose mayormente en relación al tercio medio, y ninguna en el tercio posterior. Las venas emisarias parietales drenan en el tercio medio del seno sagital superior en el 100%, mientras que las venas nasales fueron encontradas sólo en 5 casos (12,82%). Conclusión: consideramos que el conocimiento anatómico del seno sagital superior es vital en la táctica quirúrgica a fin de evitar y prever complicaciones en las cirugías que impliquen patologías de la línea media.