Seizure Freedom after Leucotomy in a Childhood Refractory Epilepsy Associated with Schizencephaly and Multifocal Cortical Malformation

Nattakarn Sripratak; Barbara Bangert; Jonathan P. Miller; Jun T. Park

doi:10.1055/s-0036-1593400

Journal of Pediatric Neurology, Inhaltsverzeichnis

Journal of Pediatric Neurology 2016; 14(04): 156-160
DOI: 10.1055/s-0036-1593400

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Seizure Freedom after Leucotomy in a Childhood Refractory Epilepsy Associated with Schizencephaly and Multifocal Cortical Malformation

Nattakarn Sripratak

¹Section of Pediatric Epilepsy, Department of Pediatrics, Case Western University School of Medicine, Cleveland, Ohio, United States

²Epilepsy Center, Department of Neurology, Neurological Institute, Case Western University School of Medicine, Cleveland, Ohio, United States

,

Barbara Bangert

³Division of Pediatric Neuroradiology, Department of Radiology, Case Western University School of Medicine, Cleveland, Ohio, United States

,

Jonathan P. Miller

⁴Division of Functional Neurosurgery, Department of Neurosurgery, Neurological Institute, Case Western University School of Medicine, Cleveland, Ohio, United States

,

Jun T. Park

¹Section of Pediatric Epilepsy, Department of Pediatrics, Case Western University School of Medicine, Cleveland, Ohio, United States

²Epilepsy Center, Department of Neurology, Neurological Institute, Case Western University School of Medicine, Cleveland, Ohio, United States

› Institutsangaben

Abstract

Schizencephaly associated with extensive malformation of cortical developments frequently cause medically intractable epilepsy in pediatric patients. Because of the extent of the structural abnormality, which is often bihemispheric and multifocal, epileptic surgery in these group of patients is typically not considered or indicated. We report a 10-year-old boy with medically intractable epilepsy and multifocal epileptiform discharges associated with bilateral malformation of cortical developments, schizencephaly, and agenesis of the corpus callosum, initially thought to be not a candidate for epilepsy surgery. All of the seizures localized to the right posterior head region. Seizure freedom was achieved after a right temporoparietooccipital (TPO) disconnection. He was followed postoperatively for 22 months at which time he remained on oxcarbazepine monotherapy. We emphasize that medically intractable epileptic patients with unilateral schizencephaly, bilateral colpocephaly, and multifocal epileptiform discharges must be evaluated with a video electroencephalography (VEEG) to characterize the seizures before ruling out epilepsy surgery as a therapeutic option. TPO disconnection surgery, instead of multilobar resections, can result in favorable seizure outcome in patients with localized seizure onset in the posterior head region.

Keywords

disconnection surgery - multifocal epileptiform discharges - refractory epilepsy - schizencephaly - seizure freedom

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Referenzen

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