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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

Neurophysiological findings (invasive recording). (A) Interictal intermitted delta activity in the medial part of the right parietal lobe. Disorganization of background activity in the medial part of the right temporal lobe. (B) Ictal activity: low-amplitude fast activity in the medial part of the right temporal lobe (Td, 1–2 — arrow) and the following sharp-wave activity in the medial part of the left parietal lobe and depression of background activity in the medial part of the left temporal lobe.
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f0010: Neurophysiological findings (invasive recording). (A) Interictal intermitted delta activity in the medial part of the right parietal lobe. Disorganization of background activity in the medial part of the right temporal lobe. (B) Ictal activity: low-amplitude fast activity in the medial part of the right temporal lobe (Td, 1–2 — arrow) and the following sharp-wave activity in the medial part of the left parietal lobe and depression of background activity in the medial part of the left temporal lobe.

Mentions: Invasive monitoring was performed with the use of intra-cerebral electrodes placed according to stereotactic methods in the medial temporal and parietal regions and nodules of heterotopia on both sides. There was a marked disorganization of background activity with periods of rhythmic theta–delta activity in the medial temporal and parietal regions on the right side during the interictal period. Ictal onset was characterized by the appearance of fast activity in the right medial temporal regions followed by the rapid spreading of epileptic discharge to the left hemisphere (Fig. 2).


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)

Neurophysiological findings (invasive recording). (A) Interictal intermitted delta activity in the medial part of the right parietal lobe. Disorganization of background activity in the medial part of the right temporal lobe. (B) Ictal activity: low-amplitude fast activity in the medial part of the right temporal lobe (Td, 1–2 — arrow) and the following sharp-wave activity in the medial part of the left parietal lobe and depression of background activity in the medial part of the left temporal lobe.
© Copyright Policy
Related In: Results  -  Collection

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

f0010: Neurophysiological findings (invasive recording). (A) Interictal intermitted delta activity in the medial part of the right parietal lobe. Disorganization of background activity in the medial part of the right temporal lobe. (B) Ictal activity: low-amplitude fast activity in the medial part of the right temporal lobe (Td, 1–2 — arrow) and the following sharp-wave activity in the medial part of the left parietal lobe and depression of background activity in the medial part of the left temporal lobe.
Mentions: Invasive monitoring was performed with the use of intra-cerebral electrodes placed according to stereotactic methods in the medial temporal and parietal regions and nodules of heterotopia on both sides. There was a marked disorganization of background activity with periods of rhythmic theta–delta activity in the medial temporal and parietal regions on the right side during the interictal period. Ictal onset was characterized by the appearance of fast activity in the right medial temporal regions followed by the rapid spreading of epileptic discharge to the left hemisphere (Fig. 2).

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