Aetiology of lesions causing epilepsy

View Details

Parent item

Seizure classification

Aetiology of lesions causing epilepsy

• Operative treatment for LEATs

Tumor	% of primary brain tumors (adults and children)	Approximate seizure frequency
DNET/ganglioglioma	1%	80-100%
Low grade glioma	9%	60-85%
Brain metastasis	N/A	24% (melanoma 67%)
Glioblastoma	17%	25-40%
Meningioma	34%	25-40%

• Dwivedi 2017

• How do we treat?

Surgical Procedure	Percentage of cases
Lobar/focal lesionectomy	48%
Hemispherotomy	16%
Multilobar resection	13%
Vagus nerve stimulator	16%
Corpus callosotomy	3%
Other	4%

• Harvey 2008

Diagnosis

Focal Cortical Dysplasia (FCD) 2a

• Extent not always seen on MRI

• Blurring of grey/white matter junction

• More challenging than 2b

Focal Cortical Dysplasia (FCD) 2b

• Most common exam

• Grey/white matter blurring

• Abnormal signal in T2 of the subcortical white matter

• Abnormal gyration/sulcation

• Transmantle sign

Glioneuronal tumour (DNET)

• Soap bubble appearance

Temporal glioneuronal tumour

Tuberous sclerosis complex

• Tubers have the same histological appearance FCD2b

• TSC have multiple tubers but generally only one or few that is a seizure focus

Neonatal hypoglycaemia

Sturge webber

MCA infarct

Hemimegalencephaly

• Presents with catostrophic epilepsy at early life

 

 

Rasmussen Encephalitis

• A progressive disease characterised by drug-resistant focal epilepsy, progressive hemiplegia, and cognitive decline, with unihemispheric brain atrophy.

• Rare condition

• Affects mostly children or young adults

• Only affects one hemisphere

• (A) Progressive right hemisphere atrophy, high signal and basal ganglia loss over 1 year (from left to right) in a child with Rasmussen’s encephalitis. The disease was mostly centred near the right Sylvian fissure (arrow).

• (B) Slowly progressive disease with more subtle right hemisphere atrophy in a child on immunosuppressant treatment at 6 months (left), 18 months (centre), and 30 months (right) of disease course.

Gelastic seizures (GS)

• Are a rare form of epilepsy characterized by inappropriate, uncontrolled laughter.
• The Joker is not a Gelastic seizures as he is aware of his laughter

• Due to Hypothalamic hamartomas
• Hamartomas of the tuber cinereum have been known to cause GS.
• Masses consisting of gray matter with large and small neurons interspersed with glial nuclei

• They are highly associated with abnormal cognitive development and behavioral problems in patients.

• Treatment Laser intersitial thermal therapy

Encephaloceles

• Encephaloceles can be associated with other features suggesting altered CSF dynamics such as:
(A) Enlargement of CSF spaces
(B) Enlarged pituitary fossa
(C) Prominent optic sheaths