Subpial transection surgery for epilepsy

Subpial transection surgery for epilepsy

BACKGROUND

Nearly 30% of patients with epilepsy continue to have seizures despite using several antiepileptic drugs (AEDs). Such patients are regarded as having refractory, or uncontrolled, epilepsy. While there is no universally accepted definition of uncontrolled, or medically refractory, epilepsy, for the purposes of this review we will consider seizures as drug resistant if they have failed to respond to a minimum of two AEDs. Specialists consider that early surgical intervention may prevent seizures at a younger age, which in turn may improve the intellectual and social status of children. Many types of surgery are available for treating refractory epilepsy; one such procedure is known as subpial transection.

OBJECTIVES

To assess the effects of subpial transection for focal-onset seizures and generalised tonic-clonic seizures in children and adults.

SEARCH METHODS

For the latest update we searched the following databases on 7 August 2018: the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to August 06, 2018), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). We imposed no language restrictions.

SELECTION CRITERIA

We considered all randomised and quasi-randomised parallel-group studies, whether blinded or non-blinded.

DATA COLLECTION AND ANALYSIS

Two review authors (BK and SR) independently screened trials identified by the search. The same two review authors planned to independently assess the methodological quality of studies. Had we identified studies for inclusion, one review author would have extracted the data, and the other would have verified the data.

MAIN RESULTS

We found no relevant studies.

AUTHORS' CONCLUSIONS

We found no evidence to support or refute the use of subpial transection surgery for patients with medically refractory epilepsy. Well-designed randomised controlled trials are needed to guide clinical practice.

Subpial transection surgery for epilepsy

BACKGROUND

Nearly 30% of patients with epilepsy continue to have seizures in spite of using several antiepileptic drug (AED) regimens. Such patients are regarded as having refractory, or uncontrolled, epilepsy. No definition of uncontrolled, or medically refractory, epilepsy has been universally accepted, but for the purposes of this review, we will consider seizures as drug resistant if they have failed to respond to a minimum of two AEDs. It is believed that early surgical intervention may prevent seizures at a younger age, which, in turn, may improve the intellectual and social status of children. Many types of surgery are available for treatment of refractory epilepsy; one such procedure is known as subpial transection.

OBJECTIVES

To determine the benefits and adverse effects of subpial transection for partial-onset seizures and generalised tonic-clonic seizures in children and adults.

SEARCH METHODS

We searched the Cochrane Epilepsy Group Specialised Register (29 June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; May 2015, Issue 5) and MEDLINE (1946 to 29 June 2015). We imposed no language restrictions.

SELECTION CRITERIA

We considered all randomised and quasi-randomised parallel-group studies, whether blinded or non-blinded.

DATA COLLECTION AND ANALYSIS

Two review authors (BK and SR) independently screened trials identified by the search. The same two review authors planned to independently assess the methodological quality of studies. When studies were identified for inclusion, one review author would have extracted the data, and the other would have verified the data.

MAIN RESULTS

We found no relevant studies.

AUTHORS' CONCLUSIONS

We found no evidence to support or refute use of subpial transection surgery for patients with medically refractory epilepsy. Well-designed randomised controlled trials are needed to guide clinical practice.

Clinicoradiological spectrum of reversible splenial lesion syndrome (RESLES) in adults: a retrospective study of a rare entity

The presence of reversible lesions that involve the splenium of the corpus callosum (SCC) has been reported in patients with a broad spectrum of diseases and conditions and is referred to as reversible splenial lesion syndrome (RESLES).To describe the clinicoradiological features and establish a clinical position for this disease, we retrospectively examined the clinicoradiological features of adult RESLES patients, as well as discuss the potential pathophysiological mechanisms of this disease.The clinical and MRI findings of patients who presented with RESLES accompanied by symptoms of neurological disorders were retrospectively reviewed. The patients were classified into 2 subgroups (favorable and poor outcome subgroups), which corresponded to the severity of the disability using the Modified Oxford Handicap Scale. In addition, we compared the clinical and neuroimaging features between the 2 outcome subgroups.Eight patients with RESLES associated with various diseases and conditions were included. The clinical presentation was nonspecific; however, MRI exhibited consistent lesions in the SCC with a hypointensity on apparent diffusion coefficient maps and a hyperintensity via diffusion-weighted imaging, which disappeared after a variable lapse. The number of patients with a severe disturbance of consciousness, extracallosal lesions, or diffuse slow waves in the poor outcome subgroup was significantly increased compared with the favorable outcome subgroup (P < 0.05). Thus, the clinicoradiological spectrum of RESLES could be classified into 2 principal categories according to differential outcomes.RESLES is a rare entity with a broad clinicoradiological spectrum because of the various diseases and conditions. Although the overall symptoms of RESLES patients tend to be alleviated, the prognosis of patients with a severe disturbance of consciousness, extracallosal lesions, or diffuse slow waves is likely unfavorable.