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Corpus callosum and epilepsies

100%

Bauer G., Płonka-Półtorak E., Bauer R., Unterberger I., Kuchukhidze G.

Journal of Epileptology

2013

vol. 21

issue 2

89-104

Introduction. Corpus callosum (CC) is the largest forebrain commissure. Structural anomalies and accompanying clinical symptoms are not in the focus of neurologists, epileptologists or neurosurgeons. Aim and method. Anatomy, embryological development, normal functions, structural abnormalities, additional malformations, clinical symptoms and seizure disorders with CC anomalies are reviewed from the literature. Review. The detection of callosal anomalies increased rapidly with widespread use of brain imaging methods. Agenesis or dysgenesis of corpus callosum (AgCC) might be considered an accidental finding. Epileptic seizures occur in up to 89% of patients with AgCC. The causal relationship correctly is questioned. However, additional causative malformations of midline and/or telencephalic structures can be demonstrated in most seizure patients. The interruption of bilateral spread of seizure activities acts as the concept for callosotomy as epilepsy surgery. Indications are drug-resistant generalized, diffuse, or multifocal epilepsies. A resectable seizure onset zone should be excluded. Most treated patients are diagnosed as Lennox-Gastaut or Lennox-like syndrome. Conclusions. In cases with callosal abnormalities and clinical symptoms additional malformations are frequently observed, especially with seizure disorders. Callosotomy is the most effective option against drop attacks. The method probably is underused. After callosotomy a circumscript seizure focus might be unveiled and a second step of resective epilepsy surgery can be successful.

The ILAE definition of drug resistant epilepsy and its clinical applicability compared with “older” established definitions

73%

Rohracher A., Dobesberger J., Granbichler C. A., Höfler J., Kuchukhidze G., Ortler M., Unterberger I., Walser G., Thomschewski A., Trinka E.

Journal of Epileptology

2015

vol. 23

issue 1

39-44

Background. Early identification of potential epilepsy surgery candidates is essential to the treatment process. Aim. To evaluate the clinical applicability of the ILAE definition of drug resistant epilepsy and its potential in identifying surgical candidates earlier compared to three established “older” definitions of drug resistant epilepsy. Material and Methods. Retrospective analysis of 174 patients who underwent epilepsy surgery between 1998 and 2009. Clinical factors and course of disease were extracted from patients' charts. Drug resistant epilepsy was classified according to four definitions and the time until fulfillment of criteria compared. Results. Mean time to fulfillment of criteria of drug resistant epilepsy ranged from 11.8 (standard deviation (SD) 9.8) to 15.6 years (SD 11.3). Time to drug resistance was significantly longer applying the only definition, requiring failure of three antiepileptic drugs (AEDs) (Canada definition), whereas time to fulfillment of all other definitions did not differ. Fifty percent of all patients experienced a seizure free period of ≥1 year prior to being classified as drug resistant, 13% entered another 1-year remission after fulfilling any criteria for drug resistance. Conclusion. We conclude that the ILAE definition identifies drug resistant epilepsy, with similar latency like two of three formerly used definitions. It is an easy applicable tool to minimize the delay of referral to a specialized center. Intermittent remissions delay assessment of drug resistance for all definitions and 13% of patients enter a remission despite established drug resistance.

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2 Journal of Epileptology

1 2015

1 2013

2 Kuchukhidze G.

2 Unterberger I.

1 Bauer G.

1 Bauer R.

1 Dobesberger J.

1 Granbichler C. A.

1 Höfler J.

1 Ortler M.

1 Płonka-Półtorak E.

1 Rohracher A.

1 Thomschewski A.

1 Trinka E.

1 Walser G.

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Corpus callosum and epilepsies

The ILAE definition of drug resistant epilepsy and its clinical applicability compared with “older” established definitions