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ID 361 – Remission of ESES after functional hemispherotomy is associated with significant language development
Abstracts / Clinical Neurophysiology 127 (2016) e18–e132
Results: A 62-year old man had a history of idiopathic generalised epilepsy with tonic-clonic seizures.Treated since the age of 30 years with phenobarbital PB 100 mg/day.He was disoriented to time and place and a slowness in mental activity over 24 h after food poisoning. Laboratory tests and a CT scan of the brain were normal.brain MRI did not show any structural lesions.EEG showed recurrent generalsed paroxysms of 3 Hz spike-wave.Normal background activity. Normalisation of mental status and EEG pattern after 1mg intravenous clonazepam (Benzodiazepine). Phenobarbital PB was substituted by valproic acid 1500 mg/day. Conclusion: Typical ASE diagnosis must be based on EEG pattern and clinical history. Efficacy of intravenous clonazepam in treatment of typical ASE. doi:10.1016/j.clinph.2015.11.289
ID 343 – Oral carbamazepine controlled temporal complex partial status epilepticus—W. Abdellaoui, S. Bahbouh, R. Benalia, M.R. Belabed, E. Attal, M. Ait-Kaci-Ahmed (Ait Idir Hospital, EEG Laboratory, Department of Neurology, Algiers, Algeria) Objective: Temporal complex partial status epilepticus TCPSE is a condition usually manifest as variable periods of confusion with a prolonged epileptic episode. In our case report on two patients with TCPSE we study the response to carbamazepine after failure of first and second line therapy. Methods: Clinical case report. Results: Case 1: A 39-year old women with cryptogenic epilepsy, was treated with phenobarbital PB 100 mg/day. Prolonged disturbed consciousness over 3 days, after abrupt withdrawal of PB. Experiencing visual and auditory hallucinations. EEG showed continuous left temporal spike/wave and slow waves discharges. Normal brain MRI. No response to intravenous Diazepam 0.15 mg/kg and PB 15 mg/kg after four days. Clinical improvement and ictal EEG pattern resolved after oral Carbamazepine CBZ treatment 600 mg/day. Case 2: A 61-year old women with symptomatic complex partial seizure disorder, secondary to CNS lymphoma. Was treated with PB 100 mg/day and CBZ600 mg/day. Confusion with agitation and experiencing visual hallucinations, after abrupt withdrawal of CBZ. EEG revealed continuous temporal slow waves. CT scanning was unchanged from imaging studies six month earlier. No response to intravenous Diazepam 0.1 mg/kg and PB 15 mg/day after three days. Improvement in her clinical delirium and EEG pattern after oral CBZ treatment 600 mg/day. Conclusion: CBZ was effective and safe in controlling TCPSE in our patients. Oral administration of CBZ is an effective alternative. doi:10.1016/j.clinph.2015.11.290
ID 358 – Hypermotor seizures in patients with temporal lobe _ Yıldırım Çapraz (Department of Neurology, epilepsy—E. Bilir, I. Faculty of Medicine, Gazi University, Ankara, Turkey) Purpose: Hypermotor seizures are considered to be characteristic of frontal lobe epilepsy, with only rare occurrence in temporal lobe epilepsy (TLE). The objective of this study was to determine the features of TLE with hypermotor seizures.
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Methods: Patients with medically refractory TLE, who underwent video-EEG monitoring between 2006 and 2015 at our epilepsy center were included the study. We retrospectively identified patients investigated whom hyperkinetic manifestations were proved to be linked to initial temporal lobe involvement. Results: We identified 6 patients with hypermotor seizures from our database. We analyzed all recorded seizures for detailed semiology and ictal EEG features. MRI and FDG-PET imaging were performed. Two patients with hypermotor seizures had implanted frontal and temporal subdural electrodes demonstrating temporal initiation and frontal spread before hypermotor behavior. Ictal EEG showed that onset of seizures were neocortical temporal lobe origin in 4 patients. Discussion: Seizures originating in the temporal lobe must be recognized as an important cause of hyperkinetic seizures. Hypermotor seizures are more common in patients with neocortical temporal lobe epilepsy than with mesial temporal lobe epilepsy. Our findings are important to recognize of TLE with hypermotor seizures and help making decision for epilepsy surgery.
doi:10.1016/j.clinph.2015.11.291
ID 361 – Remission of ESES after functional hemispherotomy is associated with significant language development—G. Gröppel a, C. Dorfer b, A. Dressler a, A. Mühlebner-Fahrngruber a, B. Porsche a, J.A. Hainfellner c, T. Czech b, M. Feucht a (a MUV/AKH Vienna, Department of Pediatrics and Adolescence Medicine, Epilepsy Monitoring Unit, Währinger Gürtel 18-20, 1090 Vienna, Austria, b MUV/AKH Vienna, Department of Neurosurgery, Währinger Gürtel 18-20, 1090 Vienna, Austria, c MUV/AKH, Institute of Neurology, Währinger Gürtel 18-20, 1090 Vienna, Austria) To study the effect of functional hemispherotomy on electrical status epilepticus during slow wave sleep (ESES) and language development. The source-population comprised prospectively collected data from patients with a history of at least 2 years after functional hemispherotomy. Study inclusion criteria were ascertained diagnosis of ESES prior to surgery and complete developmental follow-up data. A control group without ESES was drawn from the source population. Language Quotients (LQ) prior to surgery and at last follow-up were calculated. Hypotheses were: (1) Children with ESES have lower preoperative LQs than children without ESES; (2) Remission of ESES after surgery is associated with significant ‘catch up’ of the LQs. Nonparametric Wilcoxon and Chi-square tests were applied. 11 cases (five female) and 21 controls (eleven female) were included. Prior to surgery, children with ESES had significantly lower LQs compared with their controls (p = 0.015). The median follow-up after surgery was 6.0 years (±2.2; range 2–9 years). ESES remitted immediately after surgery in 90.9% of the patients. A significant increase in LQ was noticed in these children (p = 0.038). The results were independent of the side of surgery. Functional hemispherotomy may have beneficial effects on ESES and further language development. doi:10.1016/j.clinph.2015.11.292
Results: A 62-year old man had a history of idiopathic generalised epilepsy with tonic-clonic seizures.Treated since the age of 30 years with phenobarbital PB 100 mg/day.He was disoriented to time and place and a slowness in mental activity over 24 h after food poisoning. Laboratory tests and a CT scan of the brain were normal.brain MRI did not show any structural lesions.EEG showed recurrent generalsed paroxysms of 3 Hz spike-wave.Normal background activity. Normalisation of mental status and EEG pattern after 1mg intravenous clonazepam (Benzodiazepine). Phenobarbital PB was substituted by valproic acid 1500 mg/day. Conclusion: Typical ASE diagnosis must be based on EEG pattern and clinical history. Efficacy of intravenous clonazepam in treatment of typical ASE. doi:10.1016/j.clinph.2015.11.289
ID 343 – Oral carbamazepine controlled temporal complex partial status epilepticus—W. Abdellaoui, S. Bahbouh, R. Benalia, M.R. Belabed, E. Attal, M. Ait-Kaci-Ahmed (Ait Idir Hospital, EEG Laboratory, Department of Neurology, Algiers, Algeria) Objective: Temporal complex partial status epilepticus TCPSE is a condition usually manifest as variable periods of confusion with a prolonged epileptic episode. In our case report on two patients with TCPSE we study the response to carbamazepine after failure of first and second line therapy. Methods: Clinical case report. Results: Case 1: A 39-year old women with cryptogenic epilepsy, was treated with phenobarbital PB 100 mg/day. Prolonged disturbed consciousness over 3 days, after abrupt withdrawal of PB. Experiencing visual and auditory hallucinations. EEG showed continuous left temporal spike/wave and slow waves discharges. Normal brain MRI. No response to intravenous Diazepam 0.15 mg/kg and PB 15 mg/kg after four days. Clinical improvement and ictal EEG pattern resolved after oral Carbamazepine CBZ treatment 600 mg/day. Case 2: A 61-year old women with symptomatic complex partial seizure disorder, secondary to CNS lymphoma. Was treated with PB 100 mg/day and CBZ600 mg/day. Confusion with agitation and experiencing visual hallucinations, after abrupt withdrawal of CBZ. EEG revealed continuous temporal slow waves. CT scanning was unchanged from imaging studies six month earlier. No response to intravenous Diazepam 0.1 mg/kg and PB 15 mg/day after three days. Improvement in her clinical delirium and EEG pattern after oral CBZ treatment 600 mg/day. Conclusion: CBZ was effective and safe in controlling TCPSE in our patients. Oral administration of CBZ is an effective alternative. doi:10.1016/j.clinph.2015.11.290
ID 358 – Hypermotor seizures in patients with temporal lobe _ Yıldırım Çapraz (Department of Neurology, epilepsy—E. Bilir, I. Faculty of Medicine, Gazi University, Ankara, Turkey) Purpose: Hypermotor seizures are considered to be characteristic of frontal lobe epilepsy, with only rare occurrence in temporal lobe epilepsy (TLE). The objective of this study was to determine the features of TLE with hypermotor seizures.
e87
Methods: Patients with medically refractory TLE, who underwent video-EEG monitoring between 2006 and 2015 at our epilepsy center were included the study. We retrospectively identified patients investigated whom hyperkinetic manifestations were proved to be linked to initial temporal lobe involvement. Results: We identified 6 patients with hypermotor seizures from our database. We analyzed all recorded seizures for detailed semiology and ictal EEG features. MRI and FDG-PET imaging were performed. Two patients with hypermotor seizures had implanted frontal and temporal subdural electrodes demonstrating temporal initiation and frontal spread before hypermotor behavior. Ictal EEG showed that onset of seizures were neocortical temporal lobe origin in 4 patients. Discussion: Seizures originating in the temporal lobe must be recognized as an important cause of hyperkinetic seizures. Hypermotor seizures are more common in patients with neocortical temporal lobe epilepsy than with mesial temporal lobe epilepsy. Our findings are important to recognize of TLE with hypermotor seizures and help making decision for epilepsy surgery.
doi:10.1016/j.clinph.2015.11.291
ID 361 – Remission of ESES after functional hemispherotomy is associated with significant language development—G. Gröppel a, C. Dorfer b, A. Dressler a, A. Mühlebner-Fahrngruber a, B. Porsche a, J.A. Hainfellner c, T. Czech b, M. Feucht a (a MUV/AKH Vienna, Department of Pediatrics and Adolescence Medicine, Epilepsy Monitoring Unit, Währinger Gürtel 18-20, 1090 Vienna, Austria, b MUV/AKH Vienna, Department of Neurosurgery, Währinger Gürtel 18-20, 1090 Vienna, Austria, c MUV/AKH, Institute of Neurology, Währinger Gürtel 18-20, 1090 Vienna, Austria) To study the effect of functional hemispherotomy on electrical status epilepticus during slow wave sleep (ESES) and language development. The source-population comprised prospectively collected data from patients with a history of at least 2 years after functional hemispherotomy. Study inclusion criteria were ascertained diagnosis of ESES prior to surgery and complete developmental follow-up data. A control group without ESES was drawn from the source population. Language Quotients (LQ) prior to surgery and at last follow-up were calculated. Hypotheses were: (1) Children with ESES have lower preoperative LQs than children without ESES; (2) Remission of ESES after surgery is associated with significant ‘catch up’ of the LQs. Nonparametric Wilcoxon and Chi-square tests were applied. 11 cases (five female) and 21 controls (eleven female) were included. Prior to surgery, children with ESES had significantly lower LQs compared with their controls (p = 0.015). The median follow-up after surgery was 6.0 years (±2.2; range 2–9 years). ESES remitted immediately after surgery in 90.9% of the patients. A significant increase in LQ was noticed in these children (p = 0.038). The results were independent of the side of surgery. Functional hemispherotomy may have beneficial effects on ESES and further language development. doi:10.1016/j.clinph.2015.11.292