Progressive cystic lesion in a middle-aged patient with tuberous sclerosis complex: A case report.

RATIONALE: Tuberous sclerosis complex (TSC) is an uncommon multiple systems disorder. The main characteristics of the disease in the central nervous system include cortical or subcortical tubers, subependymal nodules, and subependymal giant cell astrocytoma. However, progressive cystic lesions in the cerebral hemispheres have rarely been reported in previous studies of TSC. PATIENT CONCERNS: We present the case of a 35-year-old man with TSC who was admitted to our hospital for a sudden attack of serious headache, vomiting, and left hemiplegia. Brain computerized tomography and magnetic resonance imaging (MRI) revealed multiple subependymal calcific nodes and multiple cystic lesions in the right frontal, temporal, and parietal lobes. The solid nodule in the lesion demonstrated contrast enhancement. DIAGNOSES: The patient was diagnosed with TSC, but the properties of the cystic lesion in the brain were unclear and a tumor was suspected. INTERVENTIONS: Emergency operation was performed immediately. Pathological examination of the lesion revealed a vascular malformation, but no tumor cells. OUTCOMES: In the fourth year after the surgery, brain MRI revealed a relapse of the cystic mass and surgery was suggested again. However, the patient refused to undergo surgery again. LESSONS: This case describes an atypical MRI presentation of TSC occurring in middle-age. This condition can cause a life-threatening condition and may recur after surgery. Our finding emphasizes the importance of neuroimaging surveillance in patients older than 25 years old and after lesion resection.

Clinical features and prognosis of epilepsy in the elderly in western China.

PURPOSE: To investigate the characteristics and prognosis of epilepsy amongst older people hospitalized in southwestern China with newly diagnosed epilepsy. METHODS: We prospectively enrolled people older than 65 years who were admitted to a tertiary epilepsy center in West China between January 2008 and January 2013. Participants were divided into early-onset group (those who had a first seizure before age of 65) and late-onset group (those in whom the first seizure occurred after age of 65). Clinical data were collected and all participants were followed for two years. RESULTS: Of 340 people enrolled, focal seizure (84%) was the most frequent seizure type. Status epilepticus (64.4% vs. 46.7%, p=0.022) and structural epilepsy (59.3% vs. 40.0%, p=0.015) were more prevalent in late-onset group than early-onset group. Ischemic stroke was the leading putative cause (22.6%) in elderly epilepsies. Around 80% were given anti-epileptic drugs (AEDs) for treatment. Forty-two people did not complete the study, of whom 26 were lost to follow-up and 16 died for causes other than epilepsy. Of the 298 who completed the follow-up, 240 (80.5%) achieved significant seizure reduction. Logistic regression analysis indicated that late-onset epilepsies and AEDs treatment were associated with more favorable seizure outcome at two-year follow-up (OR=4.029 and 92.007, respectively). The number of AEDs intake exerted no significant impact on seizure outcome. CONCLUSIONS: In older people, late-onset epilepsies differed in several aspects from early-onset epilepsies. The overall effectiveness of AEDs treatment in older people was satisfactory.

Efficacy of low to moderate doses of oxcarbazepine in adult patients with newly diagnosed partial epilepsy.

PURPOSE: The objective of this study was to explore the efficacy of low dose of oxcarbazepine (OXC) in adult patients with newly diagnosed partial epilepsy in an actual clinical setting. The associated factors influencing the poor control of seizures were also evaluated. METHODS: The epilepsy database (2010-2014) from the Epilepsy Clinic of West China Hospital was retrospectively reviewed. RESULTS: A total of 102 adult patients with newly diagnosed, previously untreated partial epilepsy initially treated with OXC were included, and divided into good response group (64) and poor response group (38) according to whether they were seizure-free for at least 12 months. There were 27 (26.5%) patients becoming seizure-free with OXC 600 mg/day monotherapy. The remaining 75 patients had doses of either increasing OXC to 900 mg/day (n = 59) or the addition of another antiepileptic drug (AED) (n = 16), with another 20 (19.6%) and six (5.9%) patients becoming seizure-free, respectively (P = 0.788). In addition, two (2.0%) and nine (8.8%) patients became seizure-free with OXC > 900 mg/day monotherapy and OXC ≥ 900 mg/day combination therapy, respectively. Multivariate binary logistic regression analysis revealed that the time from onset of epilepsy to treatment initiation is significantly associated with seizure control (P = 0.02). CONCLUSION: Our results indicated that OXC at low to moderate doses is effective for the treatment of Chinese adult patients with newly diagnosed, previously untreated partial epilepsy, and a longer time interval from the onset of epilepsy to the start of treatment significantly predicts poor seizure control.