98 research outputs found
SEEG in polymicrogyria: When and how?
No full textPolymicrogyria (PMG) is one of the most common malformations of cortical development (MCDs), with epilepsy affecting most patients. PMG-related drug-resistant epilepsy patients can be considered for surgery in well-selected cases. In this context, a comprehensive presurgical evaluation, often including stereo electroencephalography, is warranted to accurately delineate the epileptogenic zone. The heterogeneity of intrinsic epileptogenicity in the PMG, together with the additional or predominant involvement of remote cortical areas, calls for a different strategy in PMG compared with other MCDs, one that is not predominantly MRI- but rather SEEG-oriented. Favourable results in terms of seizure freedom and antiepileptic drug cessation are feasible in a large proportion of patients with unilateral PMG. PMG extent should not exclude the possibility of epilepsy surgery. On the other hand, patients with hemispheric PMG can be excellent hemispherotomy candidates, particularly in the presence of contralateral hemiparesis. Recent findings support early consideration of surgery in PMG-related drug-resistant epilepsy
Epilepsia
No full textObjectiveTo describe the phenomenology of monitored Sudden Unexpected Death in Epilepsy (SUDEP) occurring in the inter-ictal period where death occurs without a seizure preceding it.MethodsWe report a case series of monitored definite and probable SUDEP where no electroclinical evidence of underlying seizures was found preceding death.ResultsThree patients (2 definite and 1 probable) suffered SUDEP. They had a typical high SUDEP-risk profile with longstanding intractable epilepsy and frequent generalized tonic-clonic seizures (GTCS). All patients had varying patterns of respiratory and bradyarrhythmic cardiac dysfunction with profound EEG suppression. In two patients, patterns of cardio-respiratory failure were similar to those seen in some patients in the Mortality in Epilepsy Monitoring Units Study (MORTEMUS).SignificanceSudden Unexpected Deaths in Epilepsy (SUDEP) almost always occur postictally, after GTCS and less commonly after a partial seizure. Monitored SUDEP or near-SUDEP cases without a seizure have not yet been reported in literature. When non-monitored SUDEP occurs in an ambulatory setting without an overt seizure, the absence of EEG information prevents the exclusion of a subtle seizure. These cases confirm the existence of non-seizure SUDEP; such deaths may not be prevented by seizure detection based devices. SUDEP risk in epilepsy patients may constitute a spectrum of susceptibility wherein some are relatively immune, death occurs in others with frequent GTCS with one ultimately proving fatal, while in others still, death may occur even in the absence of a seizure. We emphasize the heterogeneity of SUDEP phenomena.U01 NS090415/NS/NINDS NIH HHS/United StatesR01 MH094480/MH/NIMH NIH HHS/United StatesU01 NS090407/NS/NINDS NIH HHS/United StatesU48 DP005008/DP/NCCDPHP CDC HHS/United StatesU01 NS090405/NS/NINDS NIH HHS/United StatesR01 EB018308/EB/NIBIB NIH HHS/United State
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