P. Dean

Surgery for Epilepsy Due to Cortical Malformations: Ten‐year Follow‐up

Summary:  Children with malformations of cortical development represent a significant proportion of pediatric epilepsy surgery candidates. From a cohort of 40 children operated on between 1980 and 1992 with malformation of cortical development, 38 were alive and had data 10 years after surgery. Age at surgery ranged from 6 months to 18 years (mean, 9.6 years). Thirty‐six had partial seizures, and two had infantile spasms; 20 were nonlesional. Pathologic diagnoses were cortical dysplasia (n = 31) and developmental tumor (n = 7). At 10‐year follow‐up, 15 (40%) were seizure free, 10 (26%) had >90% seizure reduction, and 13 (34%) were improved or unchanged. Children seizure free at two‐year follow‐up were likely to remain seizure free. Ten‐year seizure freedom was 72% in children with developmental tumors and 32% in the cortical dysplasia group. Complete resection was statistically significant for favorable outcome, and no patient with an incomplete resection was seizure free.

Low‐grade focal cortical dysplasia is associated with prenatal and perinatal brain injury

Purpose:  Prenatal and perinatal adverse events are reported to have a pathogenetic role in focal cortical dysplasia (FCD). However, no data are available regarding the prevalence and significance of this association. A cohort of children with significant prenatal and perinatal brain injury and histologically proven mild malformations of cortical development (mMCD) or FCD was analyzed.

A consensus-based approach to patient safety in epilepsy monitoring units: Recommendations for preferred practices

Patients in an epilepsy monitoring unit (EMU) with video-EEG telemetry have a risk for seizure emergencies, injuries and adverse events, which emphasizes the need for strategies to prevent avoidable harm. An expert consensus process was used to establish recommendations for patient safety in EMUs. Workgroups analyzed literature and expert opinion regarding seizure observation, seizure provocation, acute seizures, and activity/environment. A Delphi methodology was used to establish consensus for items submitted by these workgroups. Fifty-three items reached consensus and were organized into 30 recommendations. High levels of agreement were noted for items pertaining to orientation, training, communication, seizure precautions, individualized plans, and patient/family education. It was agreed that seizure observation should include direct observation or use of closed-circuit camera. The use of continuous observation was strongest in patients with invasive electrodes, at high risk for injury, or undergoing AED withdrawal. This process provides a first step in establishing EMU safety practices.

Counseling of Parents of a Child With Uncontrollable Seizures

This review deals with the problem of counseling parents of children with intractable epilepsy. The previous topics address the complexity of the pathophysiology and the treatment options available both mainstream and alternative. However, knowing the reasons for intractability or the reasons for treatment failure may be insufficient to guide the health care professional in trying to help families deal with this problem on a day-to-day basis. There is no greater challenge for the epilepsy professional than caring for this group of patients. How do we help the parents of children we cannot help? Although we may not be able to eliminate seizures, we can be accessible and listen openly. We can try and help families develop strategies, skills, and resources that empower them to manage their situation more effectively.