![]() found that a correct diagnosis of epilepsy had been reached in only 18.4% of patients ( 3). Similarly, in a series of 40 consecutive patients with ADNFLE, Oldani et al. found an absence of ictal pattern in 44% of patients, while in 51% interictal recordings failed to show any epileptiform discharges. For example, in the largest case series published so far (100 consecutive patients), Provini et al. The diagnostic confusion often stems from the absence of recorded epileptiform activity in scalp recordings either interictally and/or during the ictal events ( 1– 4). NFLE is often misdiagnosed as a sleep disturbance, as it consists of recurrent paroxysmal episodes that occur primarily or exclusively during sleep. Further investigation is needed to explain the possible causal relationships between FCD, particularly Taylor-type, and sleep-related seizures, as observed in this cohort of NFLE patients. An accurate pre-surgical evaluation, which often requires invasive EEG recording, is mandatory to define the EZ. It is concluded that patients with drug-resistant, disabling sleep-related seizures of frontal lobe origin should be considered for resective surgery, which may provide excellent results both on seizures and on epilepsy-related sleep disturbances. After 6 months post-surgery EDS had disappeared in the 9 patients who presented this complaint pre-operatively. After a post-operative follow-up of at least 12 months (mean 42.5 months) all the 16 patients with a Taylor's FCD were in Engel's Class Ia and the other 5 patients were in Engel's Classes II or III. In one case no histological change was found. Histology demonstrated a Taylor-type focal cortical dysplasia (FCD) in 16 patients and an architectural FCD in 4. Two patients were operated on twice owing to poor results after the first resection. All patients received a microsurgical resection in one frontal lobe, tailored according to pre-surgical evaluations. ![]() Eighteen patients underwent a SEEG evaluation to better define the epileptogenic zone (EZ). ![]() MRI was unrevealing in 10 cases and it showed a focal anatomical abnormality in one frontal lobe in 11 cases. Interictal and ictal EEG provided lateralizing or localizing information in most patients. All patients reported some kind of subjective manifestations. Prevalent ictal clinical signs were represented by asymmetric posturing (6 cases), hyperkinetic automatisms (10 cases), combined tonic posturing and hyperkinetic automatisms (4 cases) and mimetic automatisms (1 case). Nine patients reported excessive daytime sleepiness (EDS). ![]() There were 11 males and 10 females, whose mean age at seizure onset was 6.2 years, mean age at surgery was 24.7 years and seizure frequency ranged from 300/month. All patients underwent a comprehensive pre-surgical evaluation, which included history, interictal EEG, scalp video-EEG monitoring, high-resolution MRI and, when indicated, invasive recording by stereo-EEG (SEEG). From a consecutive series of 522 patients operated on for drug-resistant focal epilepsy, 21 cases (4%), whose frontal lobe seizures occurred almost exclusively (>90%) during sleep, were selected. Of the cases with nocturnal frontal lobe epilepsy (NFLE) 30% are refractory to antiepileptic medication, with several patients suffering from the effects of both ongoing seizures and disrupted sleep. Nobili L, Francione S, Mai R, Cardinale F, Castana L, Tassi L, Sartori I, Didato G, Citterio A, Colombo N, Galli C, Lo Russo G, Cossu M.īrain 2007 130 2:561–573. Surgical Treatment of Drug-Resistant Nocturnal Frontal Lobe Epilepsy. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |