Evaluation of efficacy and safety of anterior corpus callosotomy with keyhole in refractory seizures.

PURPOSE: This study was conducted to evaluate the efficacy and safety of anterior corpus callosotomy with a keyhole approach on refractory seizures and to evaluate this procedure for drop attacks (DAs) and generalized tonic-clonic seizures (GTCSs). METHODS: All refractory seizure patients underwent anterior corpus callosotomy (n=31) without other epilepsy surgery. Seizure response and procedure complications were evaluated. RESULTS: Seizure types included GTCS (n=26), and atonic or tonic seizures with DA (n=9). In GTCS patients, 84.6% had >or=50% decrease in seizure frequency, and 61.5% had >or=80% reduction. In DA patients, 77.8% had >or=50% decrease in seizure frequency, and 55.6% had >or=80% reduction. There were no statistically significant differences between the groups in final efficacy. Overall complication rate for corpus callosotomy was 12.9%, the permanent complication rate was 3.2%. CONCLUSIONS: Anterior corpus callosotomy with a keyhole approach produces highly favorable outcomes for both GTCS and atonic or tonic seizures with a low risk for complications.

Application of collagen sponge as an artificial dura mater in epilepsy surgery after invasive monitoring to prevent cerebrospinal fluid leakage / 中华神经医学杂志

Objective To analyze the effect of collagen sponge as an artificial dura mater on repairing dural defects and preventing cerebrospinal fluid (CSF) leakage during epilepsy surgery after invasive intracranial electrode monitoring.Methods A total of 64 patients who underwent epilepsy surgery after invasive intracranial electrode monitoring in our hospital from January 2009 and June 2012 were involved in this study.Forty-nine patients were divided into two groups according to the methods using dural substitute for the closure of dural defects.Group A consisted of 22 patients,whose dural substitutes were placed on the dural defect after the dura mater was sutured.Group B consisted of 27patients,whose dural substitutes were used subdurally before the dura mater was sutured.As a control group (group C),there were 15 patients undergoing similar epilepsy surgery without using artificial substitutes.Results Five patients from group C (33.3％) had the postoperative complication of CSF leakage and subsequent accumulative liquid under scalp flap,whereas 5 patients were found in group A (22.7％) and 2 patients in group B (7.4％) with significant difference (P＜0.05).All patients were treated by compression bandaging after manual drainage.Two patients in group A and three patients in group C were cured by closed continuous drainage of CSF via lumber subarachnoid catheter.Conclusions Using collagen sponge as an artificial substitute during epilepsy surgery can reconstruct the integrity of dura mater and reduce the incidence of CSF leakage.Artificial dura mater used subdurally is more effective than that used extradurally in preventing CSF leakage.

Clinical investigation of vagus nerve stimulation for treatment of drug-resistant epilepsy / 中华神经医学杂志

Objective To explore the effectiveness and surgical procedures of vagus nerve stimulation (VNS) therapy in patients with drug-resistant epilepsy.Methods Fourteen patients with drug-resistant epilepsy,admitted to our hospital from January 2007 to January 2011,including 6 with epilepsy after cephalitis,3 with epilepsy after head trauma and 5 with idiopathic epilepsy,were chosen in our study; their clinical data were retrospectively analyzed.VNS was performed in all the patients; the initial programming settings were as follows:output current 0.25 mA,frequency 30 Hz,pluse width 500 μs,ON 30 s and OFF 5 min.The optimum settings for each patient should balance the goals of maximizing efficacy,minimizing side effects,and preserving better life.Results The patients experienced a median seizure frequency reduction of 63.6％ after 6-44 months of VNS therapy,including 3 patients having ＜50％ seizure reduction,11 (78.6％) having ＞or=50％ seizure reduction,6 (42.3％)having ＞80％ seizure reduction,and 2 (14.3％) having seizure free.Seizure termination or seizure diminution was reported in 5 (35.7％) patients after using the magnet.Conclusion VNS is a safe and effective therapy and could improve the quality of life in patients with drug-resistant epilepsy; VNS is also effective for patients with symptomatic generalized epilepsy.

Corpus callosotomy by improved small bone window in patients with refractory epilepsy / 中华神经医学杂志

Objective To summarize the effectiveness of improved surgical techniques of corpus callosotomy in patients with refractory epilepsy. Methods A retrospective analysis was performed on the clinical data of 36 patients with refractory epilepsy, admitted to our hospital from July 2003 to July 2010; the incision via improved small bone window was summarized on skin incision,bone flap design, surgical advantages and disadvantages, and intraoperative precautions. Results A S-shaped or an approximately U-shaped incision was made in the right frontal scalp.The craniotomy was performed with a small trapezoid bone window (the topline,the baseline and the height:2,4 and 2.5 cm,respectively). With the help of microscope,the extent of sectioning consisted of the anterior 2/3 of the total length of the corpus callosum.Post-surgical outcome was assessed according to Engel's scale scores for 9 to 12 months of follow-up:6 patients were in grade Ⅰ,14 in grade Ⅱ,12 in grade Ⅲ and 4 in grade Ⅳ. Conclusion Improved corpus callosotomy has such advantages as little damage to the tissues,few complications and quick recovery,indicating that it is worth for further generalization.

Predictors of outcome in the surgical treatment for epilepsy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom.</p><p><b>METHODS</b>We retrospectively reviewed seizure outcomes and clinical, electroencephalography (EEG), magnetic resonance imaging (MRI), histopathology, and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up. Seizure outcomes were categorized based on the modified classification by the International League Against Epilepsy.</p><p><b>RESULTS</b>We found that the seizure-free rate was 27.9% after one year, and that it stabilized at about 20.0% between two and six years after surgery. Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis, MRI with visible focal lesions concordant with EEG, and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome. On the other hand, seizure recurrence within six months, incomplete focus resection, and surgical complications were associated with a poor outcome. Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome (P < 0.01). Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome (P < 0.01).</p><p><b>CONCLUSION</b>Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome, whereas seizure recurrence within six months is associated with a poor outcome.</p>

Pregnancy outcomes in women with heart disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As the Shanghai Obstetrical Cardiology Intensive Care Center, our hospital has accumulated a large number of clinical data of pregnant women with heart disease. This paper is a retrospective analysis of 1142 pregnancies in women with heart disease so as to evaluate the maternal and fetal outcomes of these patients.</p><p><b>METHODS</b>A retrospective analysis was carried out for pregnancies in 1142 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between 1993 and 2007.</p><p><b>RESULTS</b>In this study, main heart diseases in pregnancy were arrhythmia (n = 359, 31.4%), congenital heart disease (CHD; n = 291, 25.5%), and myocarditis and its sequelae (n = 284, 24.9%); based on the functional classification criteria of New York Heart Association (NYHA), more than half (n = 678, 59.4%) of patients were classified NYHA Class I; pregnant women in NHYA Class I-II (n = 951, 83.3%) commonly had arrhythmia, myocarditis and its sequelae, while those in NHYA Class III-IV (n = 191, 16.7%) mainly had CHD, rheumatic heart disease (RHD), cardiopathy induced by hypertensive disorders complicating pregnancy, and peripartum cardiomyopathy (PPCM). Cardiac failure occurred in 97 (8.5%) patients, and 8 (0.7%) maternal deaths and 12 (1.1%) perinatal deaths were reported in this study. Compared with those in NHYA Class I-II, women in NHYA Class III-IV had a significantly lower gestational age at birth (P < 0.05), lower birth weight (P < 0.01), and higher incidence of preterm delivery, small for gestational age and perinatal death (P < 0.01). The incidence of cardiac failure in pregnant women with cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM was relatively high, with a rate of 80% and 52.2%, respectively. After cardiac operation, 131 (90.3%) women were in classified NHYA Class I-II and 14 (9.7%) in NHYA Class III-IV.</p><p><b>CONCLUSIONS</b>Arrhythmia is the type of heart disease that has a highest incidence in patients with heart disease in pregnancy, while main types of heart disease that impair cardiac function are CHD and RHD; cardiac failure is more frequently caused by cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM; impaired cardiac function increases perinatal morbidity; cardiac surgery before pregnancy could improve the cardiac function.</p>