[Epilepsy surgery for refractory neurocysticercosis-related epilepsy]. / Cirugia en epilepsia refractaria debida a neurocisticercosis.

INTRODUCTION: Neurocysticercosis is one of the most frequent causes of epilepsy worldwide, with some cases going into refractoriness. For that reason, surgical treatment should be considered, particularly lesionectomy, with or without temporal lobectomy. CASE REPORTS: From our series of patients with drug-resistant epilepsy from 2008 to 2018, we selected all cases with one or more lesions suggestive of neurocysticercosis who underwent epilepsy surgery. Three patients fulfilled the inclusion criteria, with an average age of 39.33 year-old, two were female, epilepsy onset was at a mean age of 17.33 years. One case had multiple neurocysticercosis lesions and mesial temporal sclerosis, the other two cases had single neurocysticercosis lesions in the temporal region. In all cases, the epileptogenic zone was located in the temporal lobe. One patient underwent a temporal lobectomy, while the other two underwent lesionectomy. Pathology confirmed neurocysticercosis granuloma. All three cases remain seizure free. CONCLUSION: Evaluation of patients with neurocysticercosis-related refractory epilepsy for potential surgery is indicated, as this procedure can be quite successful.

TITLE: Cirugia en epilepsia refractaria debida a neurocisticercosis.Introduccion. La neurocisticercosis es una causa frecuente de crisis epileptica en el mundo, y en algunos casos puede llegar a ser farmacorresistente, por lo cual las opciones quirurgicas deben estar presentes y la lesionectomia, con o sin lobectomia temporal, es la cirugia de eleccion. Casos clinicos. De la serie de pacientes con epilepsia farmacorresistente entre los años 2008 a 2018, se seleccionaron los que tenian una o varias lesiones sugerentes de neurocisticercosis y que se sometieron a cirugia de la epilepsia. Tres pacientes cumplian los criterios de seleccion, dos de ellos mujeres, con una edad media de 39,33 años. La edad media de inicio de la epilepsia fue a los 17,33 años, con diagnostico de cisticercosis confirmado a la edad de 30. Uno de los casos tenia multiples lesiones de neurocisticercosis junto con esclerosis mesial temporal, y los otros dos, lesiones unicas en el lobulo temporal. En todos los pacientes, la zona epileptogena se localizo en el lobulo temporal correspondiente. Por lo tanto, en dos casos se realizo una lesionectomia, y en el otro, con multiples lesiones, una lobectomia temporal. La patologia de las lesiones sugiere estadios cronicos de neurocisticercosis. Todos los pacientes estan libres de crisis en el momento actual. Conclusion. La evaluacion para cirugia de la epilepsia en pacientes con epilepsia refractaria debida a neurocisticercosis esta recomendada y puede ser eficaz en el control y tratamiento de las crisis.

Postoperative axonal changes in the contralateral hemisphere in children with medically refractory epilepsy: A longitudinal diffusion tensor imaging connectome analysis.

To determine brain plasticity changes due to resective epilepsy surgery in children, we performed a longitudinal connectome analysis on the pattern of axonal connectivity in the contralateral hemisphere. Pre- and postoperative diffusion tensor imaging (DTI) data were acquired from 35 children with intractable focal epilepsy. A total of 54 brain regions of interest (ROIs) were generated in the hemisphere contralateral to the resection. Within a 54 × 54 connectivity matrix, a pairwise connectivity score was calculated for each connection between two ROIs, based on the DTI fiber streamline number in each connection. A permuted Spearman's ρ-rank analysis was used to identify specific inter-regional connections showing a significant association between the postoperative change of connectivity score and clinical variables. Nineteen connections in the contralateral hemisphere showed postoperative increases in the strength of connectivity. Postoperative increase in connectivity between insular-inferior frontal operculum regions as well as that between superior frontal orbital and mid frontal orbital regions were both significantly associated with a larger surgical resection volume (ρ > +0.40) and a younger patient age (ρ > -0.34). These increases were more robust in patients with frontal resection and in those achieving seizure freedom. Neuropsychological evaluation on subsets of patients revealed that such increases in connectivity were associated with preserved or improved cognitive functions such as visual memory and planning. Resective epilepsy surgery may lead to increased contralateral axonal connectivity in children with focal epilepsy. Our data lead to a hypothesis that such increased connectivity may be an imaging marker of postoperative brain plasticity to compensate for cognitive function. Hum Brain Mapp 37:3946-3956, 2016. © 2016 Wiley Periodicals, Inc.