Abstract Details

Title Pre-Surgical Evaluation and Management of Drug-Resistant Post-Stroke Epilepsy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 083

Objective To provide a descriptive analysis on the presurgical evaluation and surgical management of a cohort of patients with drug-resistant post-stroke epilepsy (DR-PSE).

Background PSE is usually controlled with anti-seizure medication. Surgical management in this set of patients has rarely been reported. There are no publications addressing the results of different modalities used in the presurgical assessment, including intracranial EEG (iEEG) and the surgical options in a heterogeneous set of patients with DR-PSE.

Design/Methods We examined the clinical characteristics, results of non-invasive and invasive presurgical evaluation, surgical management and prognosis of all consecutive patients with DR-PSE in our institution from January 1, 2013 to January 1, 2020.

Results Twenty-one of 420 patients (5%) who underwent iEEG, resective epilepsy surgery and/or VNS placement, had DR-PSE. Thirteen patients had iEEG. The ictal onset was seen within the stroke lesion in eight of these patients and at the mesial temporal region in 11 patients. The posterior margin of the stroke lesion was always involved. Eight patients underwent surgery without previous iEEG. MRI showed MTS in addition to the stroke lesion in five patients. In total, 10 patients had resective surgery and two had corpus callosotomy. Six patients had VNS placement. Nine (75%) patients who had surgery were Engel 1 or 2 and two (50%) of those with VNS placement who were available for follow up had more than 50% of seizure reduction rate.

Conclusions We found that seizures in patients with DR-PSE were more frequently originated in the mesial temporal region than in the stroke lesion itself. Despite the complex epileptic network underlying DR-PSE, a thorough presurgical assessment and adequate use of surgical options can lead to excellent surgical outcomes.

Authors/Disclosures
Miguel Arevalo Astrada PRESENTER	Miguel Arevalo Astrada has nothing to disclose.
	No disclosure on file
Ana Suller Marti, MD (University Hospital London Ontario)	Dr. Suller Marti has nothing to disclose.
	No disclosure on file
	No disclosure on file
Seyed M. Mirsattari, MD, PhD, FRCPC (Mayo Clinic)	Dr. Mirsattari has nothing to disclose.
David C. Diosy, MD	Dr. Diosy has nothing to disclose.
	No disclosure on file
Jorge G. Burneo, MD, MSPH, F�鶹��ýӳ�� (University of Western Ontario)	Dr. Burneo has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier, Clinical Neurology and Neurosurgery Journal. Dr. Burneo has received research support from The Jack Cowin Endowed Chair in Epilepsy Research. Dr. Burneo has received publishing royalties from a publication relating to health care. Dr. Burneo has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Jazz Pharmaceuticals.

�鶹��ýӳ��

�鶹��ýӳ��