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Deep brain stimulation has been used in increasing frequency to treat refractory epilepsy. Different targets have been tried, and different epileptic syndromes have been addressed in different ways. We describe the current targeting techniques for the structures presently most often implanted, namely the anterior nucleus of the thalamus, the centromedian nucleus of the thalamus, and the hippocampus.
ObjectivesWe investigated the prevalence of post–epilepsy surgery psychogenic nonepileptic seizures (PNES) in patients with drug‐resistant epilepsy and the possible influence of risk factors on these seizures.
MethodsIn this retrospective study, we examined data from all patients with a clinical diagnosis of drug‐resistant epilepsy who underwent epilepsy surgery at Graduate Hospital and the Jefferson...
We investigated clinical factors associated with seizure clustering in patients with drug‐resistant focal epilepsy and any association between seizure clustering and outcome after surgery. We performed a retrospective study including patients with a diagnosis of drug‐resistant focal epilepsy who underwent epilepsy surgery. Patients were prospectively registered in a database from 1986 until 2015....
Surgical techniques may vary extensively between centers. We report on a web‐based survey aimed at evaluating the current technical approaches in different centers around the world performing epilepsy surgery in children. The intention of the survey was to establish technical standards. A request was made to 88 centers to complete a web‐based survey comprising 51 questions. There were 14 questions...
The older adult population has a higher incidence and prevalence of epilepsy than any other age group. Despite the relatively common occurrence of chronic seizures in older adults, epilepsyis often misdiagnosed and left untreated in a large proportion of patients. This chapter reviews, the etiology, pathophysiology, diagnosis and management of seizures and epilepsy in the older adult.
ObjectiveThere are limited data on the indications for the use of chronic invasive electroencephalography (EEG) monitoring (IEM) for pediatric epilepsy surgery.
MethodsWe retrospectively studied 102 children who underwent intracranial monitoring to map critical cortex, localize the epileptogenic region, or resolve divergent findings. We assessed IEM utility based on changes to the resection plan...
ObjectiveCognitive rehabilitation (CR) is a well‐researched therapeutic option for a variety of neurocognitive problems. Recently, CR has been proposed as an option for patients who experience cognitive difficulties following epilepsy surgery (ES). However, there is inconsistency in reporting the efficacy of CR in this population. We appraise existing evidence regarding CR approaches in patients undergoing...
ObjectiveOver the past decades, the number of epilepsy surgeries in children has increased and indications for surgery have broadened. We studied the changes in patient characteristics between 1990 and 2011 in a nationwide cohort and related these to seizure outcome and postoperative medication status. Second, we tried to identify predictors for seizure outcome after pediatric epilepsy surgery.
MethodsTo...
ObjectiveDespite significant underutilization of surgical treatment for drug‐resistant epilepsy, no studies have quantified patient desire for surgery within a representative population. The main objective was to determine desire for surgery in a sample with a high proportion of potential candidates to characterize patient‐related barriers to the treatment. Secondary objectives included assessing...
ObjectiveHerein we present a single‐center retrospective study of patients who underwent epilepsy surgery for seizures arising from the sensorimotor (rolandic) cortex. The goal was to find prognostic factors associated with better seizure outcome and to evaluate both surgical and neurologic outcomes.
Patients, methods, and materialsA total of 66 patients fulfilled eligibility criteria and were included...
Gelastic seizures associated with hypothalamic hamartomas (HHs) are a clinicoradiologic syndrome presenting with a variety of symptoms, including pharmacoresistant epilepsy with multiple seizure types, electroencephalography (EEG) abnormalities, precocious puberty, behavioral disturbances, and progressive cognitive deterioration. Surgery in adults provides seizure freedom in only one third of patients...
Purpose: To systematically review primary research examining patient satisfaction with epilepsy surgery in order to obtain evidence‐based estimates of this surgical outcome; to assess methods used to measure epilepsy surgery satisfaction, overall epilepsy surgery satisfaction ratings, and predictors of epilepsy surgery satisfaction.
Methods: Systematic review of published studies in English up to...
Purpose: Focal cortical dysplasia type IIb (FCD IIb) lesions are highly epileptogenic and frequently cause pharmacoresistant epilepsy. Complete surgical resection leads to seizure freedom in most cases. However, the term “complete” resection is controversial with regard to the necessity of performing resections of the subcortical zone, which is frequently seen in these lesions on magnetic resonance...
Purpose: The existing data on the implications of the characteristics of seizures that recur during the first year following epilepsy surgery on subsequent seizure outcome are conflicting. We investigated the impact of recurrent seizures in the first postoperative year and their attributes on long‐term seizure outcome.
Methods: We studied the postoperative courses of 492 patients who had completed...
Purpose: The aim of this study was to assess the incidence of mild (≤90°) versus severe (>90° from vertical) visual field defects (VFDs) in patients after anterior temporal lobectomy (ATL), and their postoperative improvement over time.
Methods: The angles of postoperative VFDs of 75 patients who underwent ATL were recorded at various time points (1, 2, 6, 12, 18, 24, and 36+ months).
Results: ...
Ictal single photon emission computed tomography (SPECT) is a powerful tool for noninvasive seizure localization, but it has been underutilized because of practical challenges, including difficulty in implementing ictal‐interictal SPECT difference analysis. We previously validated a freely available utility for this purpose, ictal‐interictal subtraction analysis by statistical parametric mapping (SPM)...
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