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Published on: December 18, 2016
Epilepsy surgery for postinfectious lesions: A review
Georgia Ramantani1, Antonio Giulio Gennari2, Hans Holthausen3
1University Children's Hospital, Department of Neuropediatrics, and University of Zurich, Zurich, Switzerland.
Abstract:
Cerebral infections are a common cause of structural focal epilepsy, particularly in developing countries, where the risk of unprovoked seizures is higher and is related to brain lesions and status epilepticus during the acute phase. Despite the prevalence of pharmacoresistant epilepsy after cerebral infections, few patients are referred for epilepsy surgery. However, those with mesial temporal sclerosis (MTS), particularly linked to meningitis or encephalitis in early life, are excellent surgical candidates. Encephalitis before age four is associated with MTS, indicating a period of hippocampal vulnerability. Temporal resections are the most common procedures in these patients. In contrast, extratemporal resections are less common and generally less successful, especially in patients with multifocal epilepsy or parasitic infections. Patients with severe hemispheric damage from infections and contralateral hemiparesis may undergo hemispheric procedures, with overall favorable outcomes. Surgery for post-viral encephalitis, such as herpes simplex virus encephalitis, is often less effective due to widespread brain involvement, though younger patients with unilateral hippocampal atrophy fare better. Although neurocysticercosis is a leading cause of epilepsy in endemic regions, surgery is rarely performed. However, resecting MTS along with calcified lesions can improve seizure control in pharmacoresistant cases. This review emphasizes the importance of surgery for appropriately selected patients with postinfectious epilepsy.
Insights
Epilepsy surgery can be highly effective for patients with post-cerebral infection epilepsy, especially those with mesial temporal sclerosis (MTS). Careful patient selection is crucial for successful surgical outcomes in managing this challenging condition.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Cerebral infections are a significant cause of focal epilepsy, particularly in developing nations.
- Pharmacoresistant epilepsy is common post-infection, yet surgical referral rates remain low.
- Mesial temporal sclerosis (MTS), often linked to early-life meningitis or encephalitis, predicts good surgical outcomes.
Purpose of the Study:
- To review the role and outcomes of epilepsy surgery in patients with post-infectious epilepsy.
- To identify patient subgroups who are optimal candidates for surgical intervention.
- To highlight the importance of surgical management for selected cases of post-infectious epilepsy.
Main Methods:
- Literature review focusing on epilepsy surgery in the context of cerebral infections.
- Analysis of surgical outcomes based on epilepsy etiology, lesion type, and surgical procedure.
- Evaluation of factors influencing surgical success, including patient age and specific infection types.
Main Results:
- Temporal resections are most common and successful for MTS-related epilepsy.
- Extratemporal resections are less successful, particularly in multifocal or parasitic infections.
- Hemispheric procedures can yield favorable outcomes in severe unilateral cases; post-viral encephalitis surgery is variable.
Conclusions:
- Epilepsy surgery offers significant benefits for carefully selected patients with post-infectious epilepsy.
- Early identification and referral for surgical evaluation are critical for improving seizure control.
- Further research into optimizing surgical strategies for diverse post-infectious epilepsy etiologies is warranted.
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