Stefan Kuczaty

Rasmussen encephalitis: Incidence and course under randomized therapy with tacrolimus or intravenous immunoglobulins

Purpose:  Rasmussen encephalitis (RE) leads to progressive tissue and function loss of one brain hemisphere and often intractable epilepsy. This is the first randomized prospective treatment trial in RE.

Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery.

Antiepileptic drugs (AEDs) have cognitive side effects that, particularly in children, may affect intellectual functioning. With the TimeToStop (TTS) study, we showed that timing of AED withdrawal does not majorly influence long‐term seizure outcomes. We now aimed to evaluate the effect of AED withdrawal on postoperative intelligence quotient (IQ), and change in IQ (delta IQ) following pediatric epilepsy surgery.

Neuropsychological results in pediatric patients with epilepsy surgery in the parietal cortex.

This study evaluated pre‐ and postoperatively cognitive functions in 15 pediatric patients with surgically treated parietal lobe epilepsy (PLE). Seizure outcome was very satisfying with 87% seizure‐free patients 1 year after surgery, and 82% in the long‐term follow‐up. Preoperative intelligence was in the subaverage range. Impairments in specific cognitive functions (memory, attention, executive functions) were evident preoperatively for 39–66% of patients. Behavioral disorders were rare. No side differences (left versus right PLE) were indicated pre‐ or postoperatively. Postoperative improvements were found in behavior and attention; other cognitive functions were unchanged. All in all, this preliminary study indicated a satisfactory neuropsychological outcome in pediatric patients with PLE.

Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery

The objective of this study was to create a clinically useful tool for individualized prediction of seizure outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. We used data from the European retrospective TimeToStop study, which included 766 children from 15 centers, to perform a proportional hazard regression analysis. The 2 outcome measures were seizure recurrence and seizure freedom in the last year of follow‐up. Prognostic factors were identified through systematic review of the literature. The strongest predictors for each outcome were selected through backward selection, after which nomograms were created. The final models included 3 to 5 factors per model. Discrimination in terms of adjusted concordance statistic was 0.68 (95% confidence interval [CI] 0.67‐0.69) for predicting seizure recurrence and 0.73 (95% CI 0.72‐0.75) for predicting eventual seizure freedom. An online prediction tool is provided on www.epilepsypredictiontools.info/ttswithdrawal. The presented models can improve counseling of patients and parents regarding postoperative antiepileptic drug policies, by estimating individualized risks of seizure recurrence and eventual outcome.

Interiktale epilepsietypische EEG-Aktivität Risiko für transitorische oder permanente kognitive Einbußen?

ZusammenfassungEin erhöhtes Risiko für die kognitive Entwicklung von Kindern mit Epilepsie ist bekannt. Als Risikofaktoren werden u. a. bestimmte Epilepsieformen wie das West-Syndrom, fehlende Anfallsfreiheit unter antiepileptischer Therapie oder frühes Alter bei Krankheitsausbruch diskutiert. Inwieweit das isolierte Auftreten von interiktalen elektroenzephalographischen epilepsietypischen Potenzialen (ETP) als zusätzlicher Risikofaktor für die intellektuelle Entwicklung bei Kindern mit und ohne Epilepsie anzusehen ist bzw. welche Bedeutung dieses für die postoperative Verlaufsbeurteilung bei der Epilepsiechirurgie hat, wird in einem Literaturüberblick über die wichtigsten Studienergebnisse vorgestellt. Die sich daraus ergebenden Konsequenzen für die Praxis, insbesondere für die medikamentöse antiepileptische Therapie sowie auch für die neuropsychologische Verlaufsdiagnostik, werden herausgearbeitet.AbstractIncreased risks for the cognitive development in children with epilepsy are known. These are related to several epileptic syndromes such as West-Syndrome or other therapy refractory epilepsies (mostly from symptomatic origin) or to a very early onset. The isolated occurence of interictal epileptic electroencephalographic activity as a further risk factor for children with or without epilepsy respectively, should be also taken into account. In the following we present the various empirical findings concerning the possible role of interictal EEG activity for the neurocognitive development in affected children. Consequences for clinical practice, especially under consideration of the individual indication for the antiepileptic therapy as well as for the neuropsychological proceeding, will be presented.