Cuban strategy for the evaluation and surgical treatment of pharmaco-resistant epilepsies
Keywords:
pharmacoresistant epilepsy, presurgical evaluation, epilepsy surgery, electrocorticography, seizure outcomeAbstract
Introduction: The objective was to present the results of the first comprehensive epilepsy surgery program in Cuba.
Methods: Video-electroencephalogram (EEG) complemented with a methodology that combines non-invasive functional modalities electroencephalography (EEG) and the subtraction of ictal and interictal single photon emission computed tomography (SPECT) co-registered with magnetic resonance imaging (SISCOM) was used to estimate the location of the epileptogenic zone. In addition, estimation of ictal EEG source imaging methods was also developed.
Results: All the proposed methodology allowed for a non-invasive identification of the EZ in patients with non-lesional pharmacoresistant epilepsy. During epilepsy surgery, the intraoperative electrocorticography (ECoG) spike frequency allows for the characterization of the histopathological subtypes of mild cortical focal dysplasia in patients with Temporal Lobe Epilepsy (ELT). Pharmacoresistant temporal and extratemporal epilepsy operated patients were submitted to EEG and clinical follow-up assessment. Engel scores follow-up was described as follows: at 12 months 70,0 % class I, at 24 months after surgery 55,2 % of the patients were class I, These Engel class I ?gures changed to 48,6 % fove years following surgery, whereas 50 % maintained this condition in the last follow-up period (fourteen years). On the other hand, one year after extra temporal epilepsy surgery, 52,6 % of the patients were seizure free. Logit regression (p < 0,05) revealed that six months after surgery, quantitative EEG can be a tool to predict the outcome of epilepsy surgery. An adequate social functioning was also found.
Conclusion: Results confirm the feasibility of conducting a successful epilepsy surgery program with favorable long-term electroclinical and psychosocial functioning outcomes in a developing country as well.
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