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Partial disconnection procedure in a patient with bilateral lesions (case report).

Stepanenko AY, Arkhipova NA, Pronin IN, Shishkina LV, Lebedeva AV, Guekht AB - Epilepsy Behav Case Rep (2013)

Bottom Line: Histological examination of the cortex revealed CD type I.The patient has been seizure-free for 4 years after surgery.Partial disconnection procedures may be effective in cases where total hemispherotomy is not indicated in patients with bilateral lesions and a well-lateralized epileptogenic zone localized in the temporo-parieto-occipital region.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Moscow City Hospital No. 12, 26 Bakinskaya Street, Moscow 115516, Russian Federation.

ABSTRACT

Purpose: The method of temporal lobectomy and parietooccipital disconnection has been applied in the treatment of patients with monolateral widespread cortical lesions and with hand motor function intact. There are no data regarding the use of this method in the treatment of patients with bilateral lesions.

Case report: A case history of a 15-year-old female patient with medically refractory epilepsy is presented. Magnetic resonance imaging revealed bilateral periventricular nodular heterotopia associated with cortical dysplasia (CD) in the right temporo-parietal region. The left hemisphere had no signs of CD. Invasive monitoring revealed rhythmic theta-delta activity during the interictal period and fast activity during the ictal onset in the right temporal and parietal regions. The surgery procedure consisted of anterior temporal lobectomy, the removal of the right heterotopy nodus, the dissection of the posterior part of the corpus callosum, and the detachment of the temporo-parieto-occipital complex by dissection behind the sensorimotor cortex. Histological examination of the cortex revealed CD type I. The patient has been seizure-free for 4 years after surgery.

Conclusion: Partial disconnection procedures may be effective in cases where total hemispherotomy is not indicated in patients with bilateral lesions and a well-lateralized epileptogenic zone localized in the temporo-parieto-occipital region.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging findings in the patient: regions of cortical dysplasia (arrows); nodules of heterotopic matter (interrupted arrows).
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f0005: Magnetic resonance imaging findings in the patient: regions of cortical dysplasia (arrows); nodules of heterotopic matter (interrupted arrows).

Mentions: A 15-year-old female patient with medically refractory epilepsy was treated surgically in N. N. Burdenko Neurosurgery Institute, Moscow, in October 2008. The patient had no family history of epilepsy. Pregnancy and delivery were reported as normal. First seizures occurred at the age of 9. The patient suffered from pharmacoresistant complex partial seizures without aura appearing with loss of consciousness, aversion to the right, falling, and sometimes with secondary generalization, with a frequency of 2–4 seizures per month, without any response to antiepileptic drug therapy. Therapy on admission was as follows: valproate — 2000 mg per day and carbamazepine — 1000 mg per day. She had no neurological deficit, and she was able to attend a regular school. Magnetic resonance imaging revealed bilateral malformation of cortical development and bilateral periventricular NT associated with CD in the right temporo-parietal region; the latter appeared in slight MRI abnormalities such as thickening of the cortex and dysgyria, which could be considered as CD. Mild atrophy of the right hemisphere was also noted (Fig. 1). The left hemisphere had no signs of CD. Surface EEG recording showed bilateral interictal epileptic discharges, without any focal seizure onset.


Partial disconnection procedure in a patient with bilateral lesions (case report).

Stepanenko AY, Arkhipova NA, Pronin IN, Shishkina LV, Lebedeva AV, Guekht AB - Epilepsy Behav Case Rep (2013)

Magnetic resonance imaging findings in the patient: regions of cortical dysplasia (arrows); nodules of heterotopic matter (interrupted arrows).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150654&req=5

f0005: Magnetic resonance imaging findings in the patient: regions of cortical dysplasia (arrows); nodules of heterotopic matter (interrupted arrows).
Mentions: A 15-year-old female patient with medically refractory epilepsy was treated surgically in N. N. Burdenko Neurosurgery Institute, Moscow, in October 2008. The patient had no family history of epilepsy. Pregnancy and delivery were reported as normal. First seizures occurred at the age of 9. The patient suffered from pharmacoresistant complex partial seizures without aura appearing with loss of consciousness, aversion to the right, falling, and sometimes with secondary generalization, with a frequency of 2–4 seizures per month, without any response to antiepileptic drug therapy. Therapy on admission was as follows: valproate — 2000 mg per day and carbamazepine — 1000 mg per day. She had no neurological deficit, and she was able to attend a regular school. Magnetic resonance imaging revealed bilateral malformation of cortical development and bilateral periventricular NT associated with CD in the right temporo-parietal region; the latter appeared in slight MRI abnormalities such as thickening of the cortex and dysgyria, which could be considered as CD. Mild atrophy of the right hemisphere was also noted (Fig. 1). The left hemisphere had no signs of CD. Surface EEG recording showed bilateral interictal epileptic discharges, without any focal seizure onset.

Bottom Line: Histological examination of the cortex revealed CD type I.The patient has been seizure-free for 4 years after surgery.Partial disconnection procedures may be effective in cases where total hemispherotomy is not indicated in patients with bilateral lesions and a well-lateralized epileptogenic zone localized in the temporo-parieto-occipital region.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Moscow City Hospital No. 12, 26 Bakinskaya Street, Moscow 115516, Russian Federation.

ABSTRACT

Purpose: The method of temporal lobectomy and parietooccipital disconnection has been applied in the treatment of patients with monolateral widespread cortical lesions and with hand motor function intact. There are no data regarding the use of this method in the treatment of patients with bilateral lesions.

Case report: A case history of a 15-year-old female patient with medically refractory epilepsy is presented. Magnetic resonance imaging revealed bilateral periventricular nodular heterotopia associated with cortical dysplasia (CD) in the right temporo-parietal region. The left hemisphere had no signs of CD. Invasive monitoring revealed rhythmic theta-delta activity during the interictal period and fast activity during the ictal onset in the right temporal and parietal regions. The surgery procedure consisted of anterior temporal lobectomy, the removal of the right heterotopy nodus, the dissection of the posterior part of the corpus callosum, and the detachment of the temporo-parieto-occipital complex by dissection behind the sensorimotor cortex. Histological examination of the cortex revealed CD type I. The patient has been seizure-free for 4 years after surgery.

Conclusion: Partial disconnection procedures may be effective in cases where total hemispherotomy is not indicated in patients with bilateral lesions and a well-lateralized epileptogenic zone localized in the temporo-parieto-occipital region.

No MeSH data available.


Related in: MedlinePlus