ABSTRACT
OBJECTIVE: Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS: In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS: The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION: SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.
Subject(s)
Drug Resistant Epilepsy , Epilepsies, Partial , Epilepsy , Adolescent , Adult , Child , Child, Preschool , Drug Resistant Epilepsy/surgery , Electrodes, Implanted , Electroencephalography/methods , Epilepsies, Partial/surgery , Female , Humans , Male , Middle Aged , Stereotaxic Techniques , Young AdultABSTRACT
INTRODUCTION: Dravet's syndrome (DS) is an epileptic encephalopathy that starts in infancy and has an important impact on the lives of patients and their relatives. There is currently a need for improvement in diagnosis and treatment: two drugs have been approved for the treatment of DS in Europe, although new treatments are under development or are scheduled for commercialisation soon. AIMS: To understand the situation of DS in Spain and to identify opportunities for improvement. SUBJECTS AND METHODS: The study will involve an analysis of data from a European macro-survey in which carers of patients with DS expressed their experience with the disease. RESULTS: Data from 57 families with children with DS (mean age: 9 years). The time to diagnosis, usually after another misdiagnosis (80%), increases in older patients (80% of adults: diagnostic delay > 4 years). The delay induces an increased use of contraindicated antiepileptic drugs. Seizures (87% of cases; the most frequent, tonic-clonic: 90%) and hospitalisations (60% of cases) continue into adulthood. The severity of the illness and the number of hospitalisations correlate with impact on caregivers and family. The effectiveness of treatments and the future of patients are the greatest concerns. CONCLUSIONS: In order to improve the management and quality of life of patients with DS and their families, it is necessary to have an early diagnosis and to incorporate new treatments that help to control the epileptic seizures and the comorbidities of the disease.
TITLE: Análisis del impacto familiar y necesidades del síndrome de Dravet en España.Introducción. El síndrome de Dravet (SD) es una encefalopatía epiléptica, iniciada en la infancia, con un gran impacto en la vida de los pacientes y los familiares. Actualmente se necesitan mejoras en su diagnóstico y tratamiento: existen dos fármacos aprobados para el tratamiento del SD en Europa, aunque hay nuevos tratamientos en desarrollo o en vías de comercialización próximamente. Objetivos. Comprender la situación del SD en España e identificar las oportunidades de mejora. Sujetos y métodos. Análisis de los datos de una macroencuesta europea en la que los cuidadores de pacientes con SD manifestaron su experiencia con la enfermedad. Resultados. Datos de 57 familias con hijos con SD (edad media: 9 años). El tiempo hasta el diagnóstico, generalmente tras otro erróneo (80%), se incrementa en los pacientes de mayor edad (el 80% de los adultos: retraso diagnóstico > 4 años). La demora induce un mayor uso de fármacos antiepilépticos contraindicados. Las crisis (87% de los casos; las más frecuentes, tonicoclónicas: 90%) y las hospitalizaciones (60% de los casos) continúan hasta la edad adulta. La gravedad de la enfermedad y el número de hospitalizaciones se correlacionan con el impacto en los cuidadores y la familia. La eficacia de los tratamientos y el futuro de los pacientes son las mayores preocupaciones. Conclusiones. Para mejorar el manejo y la calidad de vida de los pacientes con SD y los familiares, es necesario un diagnóstico temprano y la incorporación de nuevos tratamientos que ayuden al control de las crisis epilépticas y de las comorbilidades de la enfermedad.
Subject(s)
Epilepsies, Myoclonic/epidemiology , Family Health , Health Services Needs and Demand , Adolescent , Anticonvulsants/therapeutic use , Caregivers , Child , Child, Preschool , Comorbidity , Cross-Sectional Studies , Delayed Diagnosis , Education, Special , Epilepsies, Myoclonic/diagnosis , Epilepsies, Myoclonic/drug therapy , Female , Humans , Male , Spain/epidemiology , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS: In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS: The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION: SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.