Successful epilepsy surgery in two cases with multiple sclerosis.

brain surgery chronic epilepsy epilepsy surgery multiple sclerosis

Journal

Epileptic disorders : international epilepsy journal with videotape
ISSN: 1950-6945
Titre abrégé: Epileptic Disord
Pays: United States
ID NLM: 100891853

Informations de publication

Date de publication:
04 Oct 2023
Historique:
revised: 19 09 2023
received: 04 08 2023
accepted: 02 10 2023
pubmed: 4 10 2023
medline: 4 10 2023
entrez: 4 10 2023
Statut: aheadofprint

Résumé

Brain surgery is the only curative treatment for people with focal epilepsy, but it is unclear whether this induces active disease in multiple sclerosis (MS). This creates a barrier to evaluate MS patients for epilepsy surgery. We present two cases of successful epilepsy surgery in patients with pharmacoresistant epilepsy and stable MS and give an overview of the existing literature. (1) a 28-year-old woman with seizures arising from a right basal temporo-occipital ganglioglioma was seizure-free after surgery, without MS relapse but with one new MS lesion postsurgically. (2) a 46-year-old woman with seizures arising from a natalizumab-associated progressive multifocal leukoencephalopathy (PML) lesion in the right frontal lobe was seizure-free after surgery preceded by extraoperative subdural electrocorticography, with new subclinical MS lesions. We are the first to report brain surgery in a PML survivor. Both patients stabilized radiologically after initiating second-line therapies. Successful epilepsy surgery can substantially increase the quality of life in patients with pharmacoresistant epilepsy and MS. With increasing survival rates of brain tumors and PML, the risk-benefit ratio of epilepsy surgery compared to a potential MS relapse after surgery becomes critically important. Shared decision-making is valuable for balancing the risks related to both diseases.

Identifiants

pubmed: 37792470
doi: 10.1002/epd2.20166
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023 The Authors. Epileptic Disorders published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.

Références

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Auteurs

Nicole van Klink (N)

Department of Neurology and Neurosurgery, Brain Center University Medical Center, Utrecht, The Netherlands.

Simon Tousseyn (S)

Academic Center for Epileptology, Maastricht University Medical Center and Kempenhaeghe, Maastricht, The Netherlands.
School for Mental Health and Neuroscience (MHeNS), University Maastricht (UM), Maastricht, The Netherlands.

Olaf Schijns (O)

Academic Center for Epileptology, Maastricht University Medical Center and Kempenhaeghe, Maastricht, The Netherlands.
School for Mental Health and Neuroscience (MHeNS), University Maastricht (UM), Maastricht, The Netherlands.
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.

Pieter van Eijsden (P)

Department of Neurology and Neurosurgery, Brain Center University Medical Center, Utrecht, The Netherlands.

Pieter Vos (P)

Department of Neurology, Slingeland hospital, Doetinchem, The Netherlands.

Danny Hilkman (D)

Academic Center for Epileptology, Maastricht University Medical Center and Kempenhaeghe, Maastricht, The Netherlands.
Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands.

Joep Killestein (J)

MS Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands.

Frans Leijten (F)

Department of Neurology and Neurosurgery, Brain Center University Medical Center, Utrecht, The Netherlands.

Classifications MeSH