- Email: [email protected]
S07. Cortical spreading depolarization in lesional epilepsy surgery
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Abstracts / Clinical Neurophysiology 129 (2018) e142–e212
hypometabolism in the right temporal region. His neuropsychological evaluation indicated difficulties in visuospatial memory and increased emotional and psychosocial distress. As the patient had drug-resistant epilepsy and his mood symptoms were worsening, the patient underwent right temporal lobectomy. He has been seizure-free, and his mood and anxiety symptoms have improved remarkably since surgery. Conclusion: Our case highlights the importance of carefully analyzing seizure semiology and correlating this with other findings. Even if a structural lesion that can be associated with seizures is identified, one cannot presume the lesion to be the cause of epilepsy. Additional tests including brain MRI with an epilepsy protocol, video EEG monitoring, PET scan and neuropsychological evaluation are necessary to determine the etiology of drug-resistant epilepsy and to provide the best treatment option. When seizures and mood disorders coexist, optimal treatment of seizures can result in alleviation of mood symptoms.
admission October, 2017 on reduced antiepileptic medications). She has been treated with a combination of lamotrigine, levetiracetam, and oxcarbazepine, currently all three, and was maintained on antiepileptic medications since 2008. Conclusion: This case illustrates the importance to recognize ECS as a cause of focal epilepsy and brain imaging lesions, and suggests a need for ECS management for seizure control. Proper diagnosis is needed to avoid ineffective brain surgery and to prompt appropriate ECS treatment. References Amaral TN et al. Semin Arthritis Rheum 2013;43(3):335–47. Doolittle DA et al. Neuroradiology 2015;57(1):21–34. Holland KE et al. Pediatrics 2006;117(1):e132–6. Peterson LS et al. J Rheumatol 1997;24(1):73–80. doi:10.1016/j.clinph.2018.04.366
doi:10.1016/j.clinph.2018.04.365
S06. A case of linear scleroderma en coup de sabre and epilepsy: Manage the sabre to control the seizures—Nicholas M. Gregg *, Thomas G. Osborn, Amy L. Kotsenas, Jeffrey Britton, Gregory D. Cascino (USA) ⇑
S07. Cortical spreading depolarization in lesional epilepsy surgery—Daniel San Juan Orta 1,*, Katia Márquez 1, Roberto Díaz Peregrino 1, Mario Alonso-Vanegas 1, Edgar Santos 2 (1 Mexico, 2 Germany) ⇑
Presenting author.
Presenting author.
Introduction: Linear scleroderma en coup de sabre (ECS) is a rare form of localized scleroderma (0.4–2.7/100,000 people) (Peterson et al., 1997) that has characteristic cutaneous involvement of the forehead and scalp (Holland et al., 2006) and is named in reference to its ‘‘stroke of a sabre”-like appearance. It typically has onset in the pediatric population and has a higher association with extracutaneous manifestations than other forms of localized scleroderma. Focal epilepsy is the most commonly reported extracutaneous manifestation of ECS, seen in 42% of reported cases (Doolittle et al., 2015). In one study, 7 of 7 patients with ECS associated epilepsy had abnormal brain imaging (Amaral et al., 2013). Methods: Ms. J is a 24 year old right handed woman with history of ECS diagnosed in 2007 involving the left forehead, refractory left temporal lobe epilepsy with onset in 2008, and a left anterior temporal lobe lesion that was resected in 2008 with reported pathology of arteriovenous malformation (AVM). Ms. J has undergone extensive evaluation by physicians in the departments of neurology and rheumatology at the Mayo Clinic since 2013, including two epilepsy monitoring unit (EMU) evaluations, ictal-SPECT scan, serial brain MRI and head and neck MRA studies, serological testing, and CSF testing. She has been treated with various antiepileptic medications, and methotrexate and mycophenolate mofetil have been used to manage her ECS. Results: Preoperative imaging of the left anterior temporal lobe lesion was retrospectively reviewed by the Mayo Clinic neuroradiology department and is not suggestive of AVM; request for pathology slides from the outside facility has been unsuccessful. Serial imaging since the resection shows new T2 hyperintensity, microhemorrages on susceptibility sequences, and scattered enhancement in the mid and posterior left temporal region, identical in appearance to the resected anterior temporal lobe lesion. Ms. J enjoyed 2 extended periods of seizure freedom, 2008 – May, 2011, and November, 2013 – November, 2016. Her seizure control correlated with treatment of her ECS: she reliably took methotrexate from 2008 – February, 2011 and mycophenolate mofetil from September, 2013 – August, 2016. She restarted mycophenolate mofetil in Jaunary, 2017 and has been seizure free since July (except for an EMU
Introduction: Cortical spreading depressions (CSDs) are waves of near-complete cellular depolarization that spread slowly across the cortical surface (2–5 mm/min) and result in transient loss of cell signaling capabilities. CSDs is a biomarker of neuronal damage described in several clinical hypoxic-ischemic conditions However, only has been found in one patient operated for Giant pituitary adenoma. Methods: This is a prospective study that included adult patients undergoing elective craniotomy for epileptogenic supratentorial lesions lasting >2 h. Electrocorticographic recordings were obtained from time of dural opening through the time of dural closure, using a standard 1 8 silver electrode coupled with a full-spectrum DC amplifier (0–45 Hz, Notch: 60 Hz). We analyzed the clinical and socio-demographic characteristics. The data were processed using the COSBID research group methodology to evaluate for slow potential changes coupled with suppression of high-frequency ECoG propagating across the electrodes. Describe statistics were used. Results: We included 16 patients, mean age 37 (19–75) years-old, 50% male, underwent 4 callosotomies and 12 temporal lesionectomies (3 cortical dysplasia, 2 cavernomas, 5 gliomas and 2 dermoid cystic). All the patients had history of symptomatic epilepsy and none had postsurgical complications and only 2 patients postcallosotomy continued with seizures at 6 months of follow-up. We didn’t find any CSD during these neurosurgeries. Conclusion: CSDs were absent during lesional epilepsy surgery. Future studies are needed to confirm these findings. doi:10.1016/j.clinph.2018.04.367
S08. Electrical stimulation of SEEG and epileptic network connectivity—Abdulrahman Alwaki *, Jeffrey Britton, Jamie Van Gompel (USA) ⇑
Presenting author.
Introduction: It has been estimated the two thirds of the human cortex lies in the sulci. Deep structures such as limbic structures, medial frontal, insular and orbital frontal regions are relatively
Abstracts / Clinical Neurophysiology 129 (2018) e142–e212
hypometabolism in the right temporal region. His neuropsychological evaluation indicated difficulties in visuospatial memory and increased emotional and psychosocial distress. As the patient had drug-resistant epilepsy and his mood symptoms were worsening, the patient underwent right temporal lobectomy. He has been seizure-free, and his mood and anxiety symptoms have improved remarkably since surgery. Conclusion: Our case highlights the importance of carefully analyzing seizure semiology and correlating this with other findings. Even if a structural lesion that can be associated with seizures is identified, one cannot presume the lesion to be the cause of epilepsy. Additional tests including brain MRI with an epilepsy protocol, video EEG monitoring, PET scan and neuropsychological evaluation are necessary to determine the etiology of drug-resistant epilepsy and to provide the best treatment option. When seizures and mood disorders coexist, optimal treatment of seizures can result in alleviation of mood symptoms.
admission October, 2017 on reduced antiepileptic medications). She has been treated with a combination of lamotrigine, levetiracetam, and oxcarbazepine, currently all three, and was maintained on antiepileptic medications since 2008. Conclusion: This case illustrates the importance to recognize ECS as a cause of focal epilepsy and brain imaging lesions, and suggests a need for ECS management for seizure control. Proper diagnosis is needed to avoid ineffective brain surgery and to prompt appropriate ECS treatment. References Amaral TN et al. Semin Arthritis Rheum 2013;43(3):335–47. Doolittle DA et al. Neuroradiology 2015;57(1):21–34. Holland KE et al. Pediatrics 2006;117(1):e132–6. Peterson LS et al. J Rheumatol 1997;24(1):73–80. doi:10.1016/j.clinph.2018.04.366
doi:10.1016/j.clinph.2018.04.365
S06. A case of linear scleroderma en coup de sabre and epilepsy: Manage the sabre to control the seizures—Nicholas M. Gregg *, Thomas G. Osborn, Amy L. Kotsenas, Jeffrey Britton, Gregory D. Cascino (USA) ⇑
S07. Cortical spreading depolarization in lesional epilepsy surgery—Daniel San Juan Orta 1,*, Katia Márquez 1, Roberto Díaz Peregrino 1, Mario Alonso-Vanegas 1, Edgar Santos 2 (1 Mexico, 2 Germany) ⇑
Presenting author.
Presenting author.
Introduction: Linear scleroderma en coup de sabre (ECS) is a rare form of localized scleroderma (0.4–2.7/100,000 people) (Peterson et al., 1997) that has characteristic cutaneous involvement of the forehead and scalp (Holland et al., 2006) and is named in reference to its ‘‘stroke of a sabre”-like appearance. It typically has onset in the pediatric population and has a higher association with extracutaneous manifestations than other forms of localized scleroderma. Focal epilepsy is the most commonly reported extracutaneous manifestation of ECS, seen in 42% of reported cases (Doolittle et al., 2015). In one study, 7 of 7 patients with ECS associated epilepsy had abnormal brain imaging (Amaral et al., 2013). Methods: Ms. J is a 24 year old right handed woman with history of ECS diagnosed in 2007 involving the left forehead, refractory left temporal lobe epilepsy with onset in 2008, and a left anterior temporal lobe lesion that was resected in 2008 with reported pathology of arteriovenous malformation (AVM). Ms. J has undergone extensive evaluation by physicians in the departments of neurology and rheumatology at the Mayo Clinic since 2013, including two epilepsy monitoring unit (EMU) evaluations, ictal-SPECT scan, serial brain MRI and head and neck MRA studies, serological testing, and CSF testing. She has been treated with various antiepileptic medications, and methotrexate and mycophenolate mofetil have been used to manage her ECS. Results: Preoperative imaging of the left anterior temporal lobe lesion was retrospectively reviewed by the Mayo Clinic neuroradiology department and is not suggestive of AVM; request for pathology slides from the outside facility has been unsuccessful. Serial imaging since the resection shows new T2 hyperintensity, microhemorrages on susceptibility sequences, and scattered enhancement in the mid and posterior left temporal region, identical in appearance to the resected anterior temporal lobe lesion. Ms. J enjoyed 2 extended periods of seizure freedom, 2008 – May, 2011, and November, 2013 – November, 2016. Her seizure control correlated with treatment of her ECS: she reliably took methotrexate from 2008 – February, 2011 and mycophenolate mofetil from September, 2013 – August, 2016. She restarted mycophenolate mofetil in Jaunary, 2017 and has been seizure free since July (except for an EMU
Introduction: Cortical spreading depressions (CSDs) are waves of near-complete cellular depolarization that spread slowly across the cortical surface (2–5 mm/min) and result in transient loss of cell signaling capabilities. CSDs is a biomarker of neuronal damage described in several clinical hypoxic-ischemic conditions However, only has been found in one patient operated for Giant pituitary adenoma. Methods: This is a prospective study that included adult patients undergoing elective craniotomy for epileptogenic supratentorial lesions lasting >2 h. Electrocorticographic recordings were obtained from time of dural opening through the time of dural closure, using a standard 1 8 silver electrode coupled with a full-spectrum DC amplifier (0–45 Hz, Notch: 60 Hz). We analyzed the clinical and socio-demographic characteristics. The data were processed using the COSBID research group methodology to evaluate for slow potential changes coupled with suppression of high-frequency ECoG propagating across the electrodes. Describe statistics were used. Results: We included 16 patients, mean age 37 (19–75) years-old, 50% male, underwent 4 callosotomies and 12 temporal lesionectomies (3 cortical dysplasia, 2 cavernomas, 5 gliomas and 2 dermoid cystic). All the patients had history of symptomatic epilepsy and none had postsurgical complications and only 2 patients postcallosotomy continued with seizures at 6 months of follow-up. We didn’t find any CSD during these neurosurgeries. Conclusion: CSDs were absent during lesional epilepsy surgery. Future studies are needed to confirm these findings. doi:10.1016/j.clinph.2018.04.367
S08. Electrical stimulation of SEEG and epileptic network connectivity—Abdulrahman Alwaki *, Jeffrey Britton, Jamie Van Gompel (USA) ⇑
Presenting author.
Introduction: It has been estimated the two thirds of the human cortex lies in the sulci. Deep structures such as limbic structures, medial frontal, insular and orbital frontal regions are relatively