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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: Coronal T2 MRI showing left trigone PVH.B: CT scan demonstrating cerebral edema from radiation necrosis.C: Dose plan for initial LINAC treatment for Case 2.D: Dose plan for second LINAC treatment for Case 2.
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f0010: A: Coronal T2 MRI showing left trigone PVH.B: CT scan demonstrating cerebral edema from radiation necrosis.C: Dose plan for initial LINAC treatment for Case 2.D: Dose plan for second LINAC treatment for Case 2.

Mentions: Scalp video-EEG demonstrated a left sphenoidal onset of seizures with 5- to 6-Hz activity and left sphenoidal interictal sharp waves. Brain MRI revealed a PVH adjacent to the trigone of the left lateral ventricle and left mesial temporal sclerosis (Fig. 2A). Depth electrodes were placed in the left hippocampus and heterotopia; left temporal subdural strip electrodes were placed as well. Video-EEG monitoring with these intracranial electrodes revealed independent seizure onsets zones in the heterotopia as well as in the left temporal neocortex. Depending on the site of onset, ictal spread occurred within 1 s between these two regions. Interictal spikes in the heterotopia, left hippocampus, and temporal neocortex were also noted.


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: Coronal T2 MRI showing left trigone PVH.B: CT scan demonstrating cerebral edema from radiation necrosis.C: Dose plan for initial LINAC treatment for Case 2.D: Dose plan for second LINAC treatment for Case 2.
© Copyright Policy
Related In: Results  -  Collection

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

f0010: A: Coronal T2 MRI showing left trigone PVH.B: CT scan demonstrating cerebral edema from radiation necrosis.C: Dose plan for initial LINAC treatment for Case 2.D: Dose plan for second LINAC treatment for Case 2.
Mentions: Scalp video-EEG demonstrated a left sphenoidal onset of seizures with 5- to 6-Hz activity and left sphenoidal interictal sharp waves. Brain MRI revealed a PVH adjacent to the trigone of the left lateral ventricle and left mesial temporal sclerosis (Fig. 2A). Depth electrodes were placed in the left hippocampus and heterotopia; left temporal subdural strip electrodes were placed as well. Video-EEG monitoring with these intracranial electrodes revealed independent seizure onsets zones in the heterotopia as well as in the left temporal neocortex. Depending on the site of onset, ictal spread occurred within 1 s between these two regions. Interictal spikes in the heterotopia, left hippocampus, and temporal neocortex were also noted.

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