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Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients.

Wu C, Sperling MR, Falowski SM, Chitale AV, Werner-Wasik M, Evans JJ, Andrews DW, Sharan AD - Epilepsy Behav Case Rep (2012)

Bottom Line: The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges.While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission.Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

View Article: PubMed Central - PubMed

Affiliation: Thomas Jefferson University Hospitals, Department of Neurological Surgery, 909 Walnut Street, Third Floor, Philadelphia, PA, USA.

ABSTRACT
Periventricular heterotopia (PVH) is a neuronal migration disorder characterized by masses of gray matter located along the lateral ventricles that commonly cause epilepsy. The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges. Noninvasive modalities of ablating this epileptogenic focus must therefore be considered. We present a small series of three patients who underwent stereotactic radiosurgery (SRS) for inoperable unilateral dominant hemisphere PVHs in order to illustrate the potential benefits and risks of this treatment modality. A total dose of 37.5-65 Gy resulted in seizure freedom for at least 14 months at the time of their last follow-up, even in patients harboring a second independent epileptic focus. Whether intracranial electrode recording truly offers added value is therefore uncertain. The two patients who received higher radiation doses suffered from symptomatic radiation necrosis and associated cerebral edema, requiring further medical intervention, and persistent monocular visual loss in one patient. While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission. Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

No MeSH data available.


Related in: MedlinePlus

A: T1 MRI demonstrating PVH in the left trigone.B: T2 Coronal MRI status-post implantation of intracranial electrodes.C: Dose plan for Case 1.D: Axial T2 MRI showing left trigone PVH.
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f0005: A: T1 MRI demonstrating PVH in the left trigone.B: T2 Coronal MRI status-post implantation of intracranial electrodes.C: Dose plan for Case 1.D: Axial T2 MRI showing left trigone PVH.

Mentions: Scalp video-EEG monitoring demonstrated left midtemporal interictal sharp waves, and seizures began focally with left sphenoidal sharp waves followed by postictal slowing in the left hemisphere. On neuropsychological testing, she demonstrated a verbal IQ of 102, performance IQ of 104, full scale IQ of 104 and Boston naming score of 44. Additionally, she had weakness in word knowledge, impaired verbal learning, working memory, and facial memory. MRI demonstrated an 8-mm periventricular heterotopia adjacent to the left trigone and associated left mesial temporal sclerosis (Fig. 1A). PET scan showed decreased metabolic activity in the left inferior temporal lobe.


Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients.

Wu C, Sperling MR, Falowski SM, Chitale AV, Werner-Wasik M, Evans JJ, Andrews DW, Sharan AD - Epilepsy Behav Case Rep (2012)

A: T1 MRI demonstrating PVH in the left trigone.B: T2 Coronal MRI status-post implantation of intracranial electrodes.C: Dose plan for Case 1.D: Axial T2 MRI showing left trigone PVH.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150677&req=5

f0005: A: T1 MRI demonstrating PVH in the left trigone.B: T2 Coronal MRI status-post implantation of intracranial electrodes.C: Dose plan for Case 1.D: Axial T2 MRI showing left trigone PVH.
Mentions: Scalp video-EEG monitoring demonstrated left midtemporal interictal sharp waves, and seizures began focally with left sphenoidal sharp waves followed by postictal slowing in the left hemisphere. On neuropsychological testing, she demonstrated a verbal IQ of 102, performance IQ of 104, full scale IQ of 104 and Boston naming score of 44. Additionally, she had weakness in word knowledge, impaired verbal learning, working memory, and facial memory. MRI demonstrated an 8-mm periventricular heterotopia adjacent to the left trigone and associated left mesial temporal sclerosis (Fig. 1A). PET scan showed decreased metabolic activity in the left inferior temporal lobe.

Bottom Line: The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges.While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission.Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

View Article: PubMed Central - PubMed

Affiliation: Thomas Jefferson University Hospitals, Department of Neurological Surgery, 909 Walnut Street, Third Floor, Philadelphia, PA, USA.

ABSTRACT
Periventricular heterotopia (PVH) is a neuronal migration disorder characterized by masses of gray matter located along the lateral ventricles that commonly cause epilepsy. The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges. Noninvasive modalities of ablating this epileptogenic focus must therefore be considered. We present a small series of three patients who underwent stereotactic radiosurgery (SRS) for inoperable unilateral dominant hemisphere PVHs in order to illustrate the potential benefits and risks of this treatment modality. A total dose of 37.5-65 Gy resulted in seizure freedom for at least 14 months at the time of their last follow-up, even in patients harboring a second independent epileptic focus. Whether intracranial electrode recording truly offers added value is therefore uncertain. The two patients who received higher radiation doses suffered from symptomatic radiation necrosis and associated cerebral edema, requiring further medical intervention, and persistent monocular visual loss in one patient. While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission. Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.

No MeSH data available.


Related in: MedlinePlus