Evaluation of intractable epilepsy. Invasive monitoring.

Accurate localization of the epileptogenic zone is the fundamental key factor for successful epilepsy surgery. Despite the progress achieved in the field of neuroimaging, invasive intracranial recording is still the gold standard that helps recognize the patient population who may profit from surgery. Meticulous implantation of intracranial electrodes and judicious interpretation of their data is a definite need in a successful epilepsy program. Few centers in the Arab world are in that domain. Moreover, the society itself is not well informed to appreciate the potentials of surgical treatment of seizure disorders. In this review article, we will go over various types of intracranial recordings, discussing their indications, and the last updates for each. Some of the cases carried out at the American University of Beirut Medical Center, Beirut, Lebanon will be illustrated as examples of our current practice. Then, the future of epilepsy monitoring will be highlighted in brief.

Endoscopy in the management of intra-ventricular lesions: preliminary experience in the Middle East.

OBJECTIVES: The study is aimed at evaluating neuroendoscopic procedures in the management of various intra-cranial intra-ventricular lesions. METHODS: We retrospectively review 24 consecutive patients harboring various intra-ventricular lesions with or without associated hydrocephalus, operated and managed by the authors between December 2002 and December 2007. Depending on the preoperative imaging and working diagnosis, endoscopic biopsy or endoscopic resection/debulking, along with concomitant treatment of hydrocephalus via third ventriculostomy or fenestration of the septum pellucidum and ventriculo-peritoneal shunting, were done. RESULTS: The single endoscopic procedure was successful in most of the patients (22/24), where the goals of surgery in attaining a diagnostic biopsy or resection, and simultaneous treatment of hydrocephalus, were attained helping guide further therapy. The endoscopic procedure was the only procedure needed in most of the patients. CONCLUSIONS: The endoscopic procedures carried a high success rate in the management of intra-ventricular lesions, and were especially valuable in patients harboring chemo and/or radiosensitive deep seated tumors.

Quality of life after vagal nerve stimulator insertion.

AIM: Assess quality-of-life after vagal nerve stimulation and determine patient characteristics associated with improvement in quality-of-life. METHODS: Sixteen patients (11 children, 5 adults) who had vagal nerve stimulation at our center were studied. Quality-of-life was assessed pre- and post-vagal nerve stimulation using the Quality-of-Life in Childhood Epilepsy questionnaire for children and the Epilepsy Surgery Inventory-55 for adults. RESULTS: Sixteen patients who did not qualify for resective surgery were included; seven (43.75%) were males and 9 (56.25%) were females. Mean age at onset of seizures was 3.96 +/- 4.00 years and at surgery was 15.78 +/- 10.78. Follow-up time was 1.26 +/- 0.92 years. Fourteen patients (87.5%) were mentally retarded. Ten (62.5%) had cryptogenic etiology and 6 patients (37.5%) symptomatic etiology. Fifty percent had localization-related epilepsy. Six of 7 patients with generalized cryptogenic etiology (85.71%) had Lennox-Gastaut syndrome. Seizures dropped from 122.31 +/- 159.49 to 67.84 +/- 88.22 seizures/month. Seizure reduction (> 50%) correlated with improvement in total quality-of-life (p = 0.034). Post-vagal nerve stimulation, the total group scored significantly higher in the social domain (p = 0.039). In patients with localization-related epilepsy, significant improvements were detected in the social domain (p = 0.049) and in total quality-of-life (p = 0.042). CONCLUSION: Despite a diverse and small population size, we observed significant improvements in the social domain 1.26 years post-vagal nerve stimulation. In addition, there was an improvement in total quality-of-life amongst patients with partial seizures. Finally, seizure reduction was associated with quality-of-life improvement. Our results support previous studies from the West reporting improvement in quality-of-life following vagal nerve stimulation, contradict those studies that did not show such differences, and are the first coming from a developing country.