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Research Interests: Psychology, Pediatrics, Epilepsy, Treatment Outcome, Adolescent, and 14 moreMedicine, Seizure, Humans, Child, Drug Resistance, Follow-up studies, Clinical Sciences, Vagus Nerve Stimulation, Retrospective Studies, Neurosciences, Vagus Nerve, Combined Modality Therapy, Child preschool, and discontinuation
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OBJECTIVE Pediatric epilepsy surgery candidates with unilateral congenital or early-acquired brain lesions may present with refractory seizures and generalized electroencephalographic features such as electrical status epilepticus in... more
OBJECTIVE Pediatric epilepsy surgery candidates with unilateral congenital or early-acquired brain lesions may present with refractory seizures and generalized electroencephalographic features such as electrical status epilepticus in sleep (ESES). The purpose of our study was to review the clinical presentation, neuroimaging findings, and outcome in a series of children with unilateral brain lesions and ESES undergoing resective surgery for refractory epilepsy. METHODS A total of 415 consecutive patients younger than 18 years of age undergoing video electroencephalographic evaluation and epilepsy surgery at Cleveland Clinic were reviewed for ESES, an underlying pathological lesion, and outcome after surgery. RESULTS Eight patients were included. All patients presented with medically refractory epilepsy, hemiparesis, and developmental delay. The pathogenesis was perinatal infarction in 7 patients and malformation of cortical development in 1 patient. Preoperative electroencephalograp...
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Research Interests: Neuroscience, Psychology, Neuroimaging, Magnetoencephalography, Magnetic Resonance Imaging, and 15 moreEpilepsy, Treatment Outcome, Medicine, Prefrontal Cortex, Temporal Lobe, Humans, Motor Cortex, Epilepsia, Clinical Sciences, Premotor cortex, Supplementary Motor Area, Single Photon Emission Computed Tomography, X ray Computed Tomography, Neurosciences, and Frontal Lobe
Psychogenic seizures in 21 nonepileptic children and adolescents, aged 8 to 18 (mean 14.5) years, were recorded by means of video recording and electroencephalography. The episodes included thrashing movements, limb jerking, or staring,... more
Psychogenic seizures in 21 nonepileptic children and adolescents, aged 8 to 18 (mean 14.5) years, were recorded by means of video recording and electroencephalography. The episodes included thrashing movements, limb jerking, or staring, with unresponsiveness. Ictal and interictal electroencephalograms showed no abnormalities after antiepileptic medication was discontinued. Fifteen patients had psychogenic seizures spontaneously during recording, and six had seizures in response to suggestion and intravenous saline injection. After the video-electroencephalographic evaluation, patients and families were told that the episodes were emotional in origin. All patients but 1 agreed to remain without antiepileptic medication, and 16 patients (76%) agreed to begin psychiatric treatment. At 6 to 66 (mean 30) months' follow-up, 14 of 18 (78%) were free of episodes. These data indicate that the majority of young patients with psychogenic seizures have a good outcome. A firm diagnosis is cr...
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Seizure outcome after epilepsy surgery in patients with
Temporal lobe epilepsy in children has been less well studied compared to that seen in adults. Whereas hippocampal sclerosis is the most common etiology for the adult temporal lobe epilepsy syndromes, tumors and malformations of cortical... more
Temporal lobe epilepsy in children has been less well studied compared to that seen in adults. Whereas hippocampal sclerosis is the most common etiology for the adult temporal lobe epilepsy syndromes, tumors and malformations of cortical development are more commonly seen in children. Differences in seizure semiology are also apparent. Temporal lobe epilepsy in very young infants may exhibit prominent motor manifestations reminiscent of extra-temporal seizures. These motor manifestations however decrease with increasing age and are less abundant in adults. Automatisms, which are commonly seen in temporal lobe epilepsy in all age groups, are simple at a younger age and become increasingly more complex and discrete with age. Several case studies, illustrated on the video are included in this review. They highlight the differences in temporal lobe seizure semiology between children and adults. [Published with video sequences].
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... A Ikeda, K Källén, C Kellinghaus, P Kotagal, D Lachhwani, T Loddenkemper, J Mani, R Matsumoto, G Möddel, D Nair, S Noachtar, CA O'Donovan, S Rona, F Rosenow,... more
... A Ikeda, K Källén, C Kellinghaus, P Kotagal, D Lachhwani, T Loddenkemper, J Mani, R Matsumoto, G Möddel, D Nair, S Noachtar, CA O'Donovan, S Rona, F Rosenow, S Schuele, CA Szabo, N Tandon, A Tanner, P Widdess-Walsh , Epilepsy Center, Cleveland Clinic Foundation ...
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We studied the usefulness of ictal single-photon emission computed tomography in the presurgical evaluation of children with partial epilepsy resulting from focal cortical dysplasia. Fifteen children, age 1-18 years, were identified with... more
We studied the usefulness of ictal single-photon emission computed tomography in the presurgical evaluation of children with partial epilepsy resulting from focal cortical dysplasia. Fifteen children, age 1-18 years, were identified with partial epilepsy caused by focal cortical dysplasia (confirmed by histology) who underwent subtraction ictal single-photon emission computed tomography during presurgical evaluation. All children later underwent surgery at the Cleveland Clinic Epilepsy Center between 1996 and 2000. The findings of ictal single-photon emission computed tomography and brain positron emission tomography were classified as localized when "localizing and concordant" with the surgical resection site, nonconcordant when "localizing but not concordant" with the surgical resection, or nonlocalized when "no well-localized region of ictal hyperperfusion was observed on the difference…
Research Interests: Adolescent, Positron Emission Tomography, Medicine, Pediatric Neurology, Humans, and 14 moreChild, Cerebral Cortex, Female, Male, Infant, Follow-up studies, Single Photon Emission Computed Tomography, Retrospective Studies, Neurosciences, Nino, Magnetic resonance image, Child preschool, Focal Cortical Dysplasia, and Paediatrics and reproductive medicine
Research Interests: Psychology, Psychopathology, Electroencephalography, Employment, Medicine, and 15 morePediatric Neurology, Prospective studies, Humans, Child, Female, Male, Mental Disorders, Social Adjustment, Early Detection, Adult, Behavior Problems, Educational Status, Neurosciences, Marital Status, and Paediatrics and reproductive medicine
OBJECTIVES. Our goals were to determine the effect of epilepsy surgery in infants (<3 years of age) on development and describe factors associated with postoperative developmental outcome. METHODS. We identified 50 infants among 251... more
OBJECTIVES. Our goals were to determine the effect of epilepsy surgery in infants (<3 years of age) on development and describe factors associated with postoperative developmental outcome. METHODS. We identified 50 infants among 251 consecutive pediatric patients (<18 years old) undergoing epilepsy surgery. Charts were reviewed for clinical data and neurodevelopmental testing with the Bayley Scales of Infant Development. A developmental quotient was calculated to compare scores of children at different ages. RESULTS. Complete data were available on 24 of 50 infants. Surgeries included 14 hemispherectomies and 10 focal resections. Seventeen patients became seizure free; 5 patients had >90% seizure reduction, 1 had >50% seizure reduction, and 1 had no change. The developmental quotient indicated modest postoperative improvement of mental age. The preoperative and postoperative development quotients correlated well. Younger infants had a higher increase in developmental quo...
Research Interests: Pediatrics, Child Development, Epilepsy, Humans, Female, and 12 moreMale, Infant Development, Infant, Follow-up studies, Cortical Development, Clinical Data, Retrospective Studies, Epilepsy Surgery, Antiepileptic Drug, Child preschool, Psychology and Cognitive Sciences, and Medical and Health Sciences
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ple daily episodes of dystonic and choreoathetotic posturing. His movements began with his rubbing his right first and second digits together, followed by extension of the wrist, flexion of the elbow, and abduction of the shoulder,... more
ple daily episodes of dystonic and choreoathetotic posturing. His movements began with his rubbing his right first and second digits together, followed by extension of the wrist, flexion of the elbow, and abduction of the shoulder, occasionally followed by head dropping. The movements lasted for seconds and could be precipitated by activity of the right arm. Birth history and early developmental motor milestones were normal. However, his language never properly developed. Physical examination revealed decreased hearing, and dressing and constructional apraxias. He was hypotonic with bilateral Hoffman and Babinski signs. Laboratory investigation, including CT and MRI, were normal. Several clinical seizures were recorded on a surface EEG with double density electrodes over the vertex (figure). The EEG study demonstrated interictal epileptiform activity between Cz and C1, and bursts of high-frequency epileptiform activity near Cz coincident with the patient's right hand movement and head dropping. The surface potential pattern of this discharge was suggestive of ictal activity arising in the SMA contralateral to the involved extremity. To support their contention that the movements were mediated by striatal involvement, Kotagal et a1 cited anatomic evidence for projections from the hippocampus and amygdala to these structures. But these pathways project to the ventral striatum and are probably not related to the motor functions of the basal ganglia.2 However, there are connections between the temporal and frontal lobes, including direct projections from the amygdala to the SMA.S The SMA, in turn, has extensive connections with the striatum that are intimately involved in motor function.* The possible spread of ictal activity from temporal lobe to frontal lobe was not specifically monitored in Kotagal's patients, since their intracranial EEGs (subdural grids) did not sample activity from the mesial frontal and cingulate areas. Furthermore, it is well known that stimulation'-6 and ictal discharge4.6.7 from the SMA or cingulate gym provoke contralateral dystonic and choreoathetotic posturing. We suggest that dystonic posturing in CPS of temporal lobe origin likely reflects spread of ictal discharge to the ipsilateral mesial frontal lobe. Consequently, this area should be carefully studied in patients with such behaviors prior to concluding spread to the basal ganglia.
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The authors reviewed preoperative MRI and EEG findings in relation to postsurgical outcome in 17 patients with refractory epilepsy due to tuberous sclerosis complex (TSC). Resecting concordant MRI (main tuber) and EEG abnormalities... more
The authors reviewed preoperative MRI and EEG findings in relation to postsurgical outcome in 17 patients with refractory epilepsy due to tuberous sclerosis complex (TSC). Resecting concordant MRI (main tuber) and EEG abnormalities offered seizure freedom (8/9, 89%; median follow-up 25 months) comparable to other focal etiologies. Patients with nonconcordant MRI and EEG findings did less well (3/8, 38%, seizure free; p = 0.027, OR = 13).
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Seizure outcome after epilepsy surgery in patients with
Temporal lobe epilepsy in children has been less well studied compared to that seen in adults. Whereas hippocampal sclerosis is the most common etiology for the adult temporal lobe epilepsy syndromes, tumors and malformations of cortical... more
Temporal lobe epilepsy in children has been less well studied compared to that seen in adults. Whereas hippocampal sclerosis is the most common etiology for the adult temporal lobe epilepsy syndromes, tumors and malformations of cortical development are more commonly seen in children. Differences in seizure semiology are also apparent. Temporal lobe epilepsy in very young infants may exhibit prominent motor manifestations reminiscent of extra-temporal seizures. These motor manifestations however decrease with increasing age and are less abundant in adults. Automatisms, which are commonly seen in temporal lobe epilepsy in all age groups, are simple at a younger age and become increasingly more complex and discrete with age. Several case studies, illustrated on the video are included in this review. They highlight the differences in temporal lobe seizure semiology between children and adults. [Published with video sequences].
Research Interests:
... A Ikeda, K Källén, C Kellinghaus, P Kotagal, D Lachhwani, T Loddenkemper, J Mani, R Matsumoto, G Möddel, D Nair, S Noachtar, CA O&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27;Donovan, S Rona, F Rosenow,... more
... A Ikeda, K Källén, C Kellinghaus, P Kotagal, D Lachhwani, T Loddenkemper, J Mani, R Matsumoto, G Möddel, D Nair, S Noachtar, CA O&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27;Donovan, S Rona, F Rosenow, S Schuele, CA Szabo, N Tandon, A Tanner, P Widdess-Walsh , Epilepsy Center, Cleveland Clinic Foundation ...
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We studied the usefulness of ictal single-photon emission computed tomography in the presurgical evaluation of children with partial epilepsy resulting from focal cortical dysplasia. Fifteen children, age 1-18 years, were identified with... more
We studied the usefulness of ictal single-photon emission computed tomography in the presurgical evaluation of children with partial epilepsy resulting from focal cortical dysplasia. Fifteen children, age 1-18 years, were identified with partial epilepsy caused by focal cortical dysplasia (confirmed by histology) who underwent subtraction ictal single-photon emission computed tomography during presurgical evaluation. All children later underwent surgery at the Cleveland Clinic Epilepsy Center between 1996 and 2000. The findings of ictal single-photon emission computed tomography and brain positron emission tomography were classified as localized when "localizing and concordant" with the surgical resection site, nonconcordant when "localizing but not concordant" with the surgical resection, or nonlocalized when "no well-localized region of ictal hyperperfusion was observed on the difference…
Research Interests: Adolescent, Positron Emission Tomography, Medicine, Pediatric Neurology, Humans, and 14 moreChild, Cerebral Cortex, Female, Male, Infant, Follow-up studies, Single Photon Emission Computed Tomography, Retrospective Studies, Neurosciences, Nino, Magnetic resonance image, Child preschool, Focal Cortical Dysplasia, and Paediatrics and reproductive medicine
Research Interests: Psychology, Psychopathology, Electroencephalography, Employment, Medicine, and 15 morePediatric Neurology, Prospective studies, Humans, Child, Female, Male, Mental Disorders, Social Adjustment, Early Detection, Adult, Behavior Problems, Educational Status, Neurosciences, Marital Status, and Paediatrics and reproductive medicine
OBJECTIVES. Our goals were to determine the effect of epilepsy surgery in infants (<3 years of age) on development and describe factors associated with postoperative developmental outcome. METHODS. We identified 50 infants among 251... more
OBJECTIVES. Our goals were to determine the effect of epilepsy surgery in infants (<3 years of age) on development and describe factors associated with postoperative developmental outcome. METHODS. We identified 50 infants among 251 consecutive pediatric patients (<18 years old) undergoing epilepsy surgery. Charts were reviewed for clinical data and neurodevelopmental testing with the Bayley Scales of Infant Development. A developmental quotient was calculated to compare scores of children at different ages. RESULTS. Complete data were available on 24 of 50 infants. Surgeries included 14 hemispherectomies and 10 focal resections. Seventeen patients became seizure free; 5 patients had >90% seizure reduction, 1 had >50% seizure reduction, and 1 had no change. The developmental quotient indicated modest postoperative improvement of mental age. The preoperative and postoperative development quotients correlated well. Younger infants had a higher increase in developmental quo...
Research Interests: Pediatrics, Child Development, Epilepsy, Humans, Female, and 12 moreMale, Infant Development, Infant, Follow-up studies, Cortical Development, Clinical Data, Retrospective Studies, Epilepsy Surgery, Antiepileptic Drug, Child preschool, Psychology and Cognitive Sciences, and Medical and Health Sciences
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ple daily episodes of dystonic and choreoathetotic posturing. His movements began with his rubbing his right first and second digits together, followed by extension of the wrist, flexion of the elbow, and abduction of the shoulder,... more
ple daily episodes of dystonic and choreoathetotic posturing. His movements began with his rubbing his right first and second digits together, followed by extension of the wrist, flexion of the elbow, and abduction of the shoulder, occasionally followed by head dropping. The movements lasted for seconds and could be precipitated by activity of the right arm. Birth history and early developmental motor milestones were normal. However, his language never properly developed. Physical examination revealed decreased hearing, and dressing and constructional apraxias. He was hypotonic with bilateral Hoffman and Babinski signs. Laboratory investigation, including CT and MRI, were normal. Several clinical seizures were recorded on a surface EEG with double density electrodes over the vertex (figure). The EEG study demonstrated interictal epileptiform activity between Cz and C1, and bursts of high-frequency epileptiform activity near Cz coincident with the patient's right hand movement and head dropping. The surface potential pattern of this discharge was suggestive of ictal activity arising in the SMA contralateral to the involved extremity. To support their contention that the movements were mediated by striatal involvement, Kotagal et a1 cited anatomic evidence for projections from the hippocampus and amygdala to these structures. But these pathways project to the ventral striatum and are probably not related to the motor functions of the basal ganglia.2 However, there are connections between the temporal and frontal lobes, including direct projections from the amygdala to the SMA.S The SMA, in turn, has extensive connections with the striatum that are intimately involved in motor function.* The possible spread of ictal activity from temporal lobe to frontal lobe was not specifically monitored in Kotagal's patients, since their intracranial EEGs (subdural grids) did not sample activity from the mesial frontal and cingulate areas. Furthermore, it is well known that stimulation'-6 and ictal discharge4.6.7 from the SMA or cingulate gym provoke contralateral dystonic and choreoathetotic posturing. We suggest that dystonic posturing in CPS of temporal lobe origin likely reflects spread of ictal discharge to the ipsilateral mesial frontal lobe. Consequently, this area should be carefully studied in patients with such behaviors prior to concluding spread to the basal ganglia.
Research Interests:
The authors reviewed preoperative MRI and EEG findings in relation to postsurgical outcome in 17 patients with refractory epilepsy due to tuberous sclerosis complex (TSC). Resecting concordant MRI (main tuber) and EEG abnormalities... more
The authors reviewed preoperative MRI and EEG findings in relation to postsurgical outcome in 17 patients with refractory epilepsy due to tuberous sclerosis complex (TSC). Resecting concordant MRI (main tuber) and EEG abnormalities offered seizure freedom (8/9, 89%; median follow-up 25 months) comparable to other focal etiologies. Patients with nonconcordant MRI and EEG findings did less well (3/8, 38%, seizure free; p = 0.027, OR = 13).