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5 results

  • Radiofrequency Thermocoagulation in Refractory Focal Epilepsy: The Montreal Neurological Institute Experience

  • Farhan A. Mirza, Jeffery A. Hall
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 48 / Issue 5 / September 2021
    Published online by Cambridge University Press:
    04 December 2020, pp. 626-639
    • Article
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  • Background:

    Radiofrequency thermocoagulation (RF-TC) is a minimally invasive ablative option for refractory focal epilepsy.

    Methods:

    A retrospective chart review was conducted of all patients who underwent stereoelectroencephalography (SEEG)-guided RF-TC at our institution.

    Results:

    Fourteen patients underwent robot-guided electrode implantation and subsequent RF-TC. After RF-TC, one of the three patients with PVNH was seizure free, one had 18 months of seizure freedom (Engel 2b), and one required temporal neocortical/PVNH resection (Engel 1a). One of the four patients with focal cortical dysplasia (FCD) was seizure free (Engel 1a), two attained seizure freedom after resection (Engel 1a and 1b), while one continues to have significant seizures (Engel 4b). One patient with cavernoma and low central area epileptogenic zone (EZ) did not benefit from RF-TC and is planned for resection. Two of the MRI-negative patients achieved seizure freedom for 3 months and 1 year, respectively, subsequently requiring resection (Engel 1a). One remains seizure free at 4 weeks. Three had seizure recurrence immediately (Engel 4b). With RF-TC alone, two patients (14%) achieved Engel 1a, two were seizure free at 1 year, one had 3 months of seizure freedom, while the rest had recurrence immediately or within a few weeks. 7/14 patients underwent secondary interventions after RF-TC. Overall, seven patients achieved Engel 1a or 1b, one each 2b and 3a, and five Engel 4b.

    Conclusion:

    At our institution, RF-TC is a safe ablative procedure for refractory focal epilepsy. It can serve as a segue to secondary interventions and appears promising in PVNH cases. Its role in MRI-negative cases is less clear.

  • Chapter 63 - Ganglioglioma, dysembryoplastic neuroepithelial tumor, and related tumors

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 441-448

  • Summary

    Focal cortical dysplasia (FCD) is a definable disorder among the malformation due to abnormal cortical development (MCD) and as such it should be recognized and diagnosed accordingly. The molecular mechanisms mediating epileptogenesis in FCD are not well understood despite the fact that FCD is one of nature's best models for intrinsic epileptogenicity. The clinical manifestations of patients with cortical FCD are variable. Ictal electroencephalogram (EEG) studies have suggested that FCD is a neural network disorder with secondary ictal zones. Intraictal activation is typical of FCD and can be contiguous or at a distance from the primary epileptogenic area. In transmantle cortical dysplasia (TCD), the imaging abnormality extends from the ventricle to the cerebral cortex. The extent and the localization in Bottom of the sulcus FCD (BOSD) distinguish it from TCD or other FCDs. New surgical treatment options that combine network disconnection and augmentation such as electrical stimulation are being developed.

  • Chapter 84 - Psychiatric disorders

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 593-606

  • Summary

    The majority of tumors that present with epilepsy comprise a group of tumors that include dysembryoplastic neuroepithelial tumors (DNT), ganglioglioma, gangliocytoma, and the more recently described angiocentric glioma. This chapter focuses on these tumors and their management is predominantly focused on seizure control. The differential diagnosis includes other low-grade epilepsy-associated tumors, cortical dysplasia, and diffuse gliomas. The chapter discusses the lesions which are distinguished from the dysplastic gangliocytoma of the cerebellum and desmoplastic infantile ganglioglioma. Ganglioglioma accounts for up to 50% of all tumors in patients undergoing surgery for control of epilepsy and is the commonest tumor associated with chronic epilepsy. The goals of management are seizure control, confirmation of the radiological diagnosis, and control of tumor growth and progression. Angiocentric glioma is a low-grade cortical tumor associated with epilepsy. The differential diagnosis includes low-grade glioneuronal tumors, focal cortical dysplasia (FCD), and diffuse glioma.