دورية أكاديمية
أعرض في EDS

Focal to bilateral tonic-clonic seizures predict pharmacoresistance in focal cortical dysplasia-related epilepsy.

التفاصيل البيبلوغرافية
العنوان: Focal to bilateral tonic-clonic seizures predict pharmacoresistance in focal cortical dysplasia-related epilepsy.
المؤلفون: Chang P; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Xie H; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Illapani VSP; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., You X; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Anwar T; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Pasupuleti A; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Vu TA; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Vezina LG; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Gholipour T; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Oluigbo CO; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Zhang A; Division of Biostatistics and Study Methodology, Children's National Research Institute, Washington, District of Columbia, USA., Gaillard WD; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA., Cohen NT; Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA.
المصدر: Epilepsia [Epilepsia] 2023 Sep; Vol. 64 (9), pp. 2434-2442. Date of Electronic Publication: 2023 Jul 07.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Blackwell Science Country of Publication: United States NLM ID: 2983306R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1167 (Electronic) Linking ISSN: 00139580 NLM ISO Abbreviation: Epilepsia Subsets: MEDLINE
أسماء مطبوعة: Publication: Malden, MA : Blackwell Science
Original Publication: Copenhagen : Munskgaard
مواضيع طبية MeSH: Focal Cortical Dysplasia* , Epilepsy*/diagnostic imaging , Epilepsy*/drug therapy , Epilepsy*/etiology , Malformations of Cortical Development*/complications , Malformations of Cortical Development*/diagnostic imaging , Malformations of Cortical Development*/surgery, Child ; Humans ; Retrospective Studies ; Treatment Outcome ; Seizures/diagnostic imaging ; Seizures/etiology ; Seizures/surgery ; Magnetic Resonance Imaging
مستخلص: Objective: Focal cortical dysplasia (FCD) is the most common etiology of surgically-remediable epilepsy in children. Eighty-seven percent of patients with FCD develop epilepsy (75% is pharmacoresistant epilepsy [PRE]). Focal to bilateral tonic-clonic (FTBTC) seizures are associated with worse surgical outcomes. We hypothesized that children with FCD-related epilepsy with FTBTC seizures are more likely to develop PRE due to lesion interaction with restricted cortical neural networks.
Methods: Patients were selected retrospectively from radiology and surgical databases from Children's National Hospital.
Inclusion Criteria: 3T magnetic resonance imaging (MRI)-confirmed FCD from January 2011 to January 2020; ages 0 days to 22 years at MRI; and 18 months of documented follow-up. FCD dominant network (Yeo 7-network parcellation) was determined. Association of FTBTC seizures with epilepsy severity, surgical outcome, and dominant network was tested. Binomial regression was used to evaluate predictors (FTBTC seizures, age at seizure onset, pathology, hemisphere, lobe) of pharmacoresistance and Engel outcome. Regression was used to evaluate predictors (age at seizure onset, pathology, lobe, percentage default mode network [DMN] overlap) of FTBTC seizures.
Results: One hundred seventeen patients had a median age at seizure onset of 3.00 years (interquartile range [IQR] .42-5.59 years). Eighty-three patients had PRE (71%); 34 had pharmacosensitive epilepsy (PSE) (29%). Twenty patients (17%) had FTBTC seizures. Seventy-three patients underwent epilepsy surgery. Multivariate regression showed that FTBTC seizures are associated with an increased risk of PRE (odds ratio [OR] 6.41, 95% confidence interval [CI] 1.21-33.98, p = .02). FCD hemisphere/lobe was not associated with PRE. Percentage DMN overlap predicts FTBTC seizures. Seventy-two percent (n = 52) overall and 53% (n = 9) of patients with FTBTC seizures achieved Engel class I outcome.
Significance: In a heterogeneous population of surgical and non-operated patients with FCD-related epilepsy, the presence of FTBTC seizures is associated with a tremendous risk of PRE. This finding is a recognizable marker to help neurologists identify those children with FCD-related epilepsy at high risk of PRE and can flag patients for earlier consideration of potentially curative surgery. The FCD-dominant network also contributes to FTBTC seizure clinical expression.
(© 2023 International League Against Epilepsy.)
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معلومات مُعتمدة: P50 HD105328 United States HD NICHD NIH HHS; UL1 TR001876 United States TR NCATS NIH HHS
فهرسة مساهمة: Keywords: FCD; default mode network; drug-resistant epilepsy; pharmacoresistant epilepsy
تواريخ الأحداث: Date Created: 20230623 Date Completed: 20230920 Latest Revision: 20231003
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC10529443
DOI: 10.1111/epi.17700
PMID: 37349955
قاعدة البيانات: MEDLINE
الوصف
تدمد:1528-1167
DOI:10.1111/epi.17700