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Optimizing of epilepsy surgery in paediatric patients
Bělohlávková, Anežka ; Kršek, Pavel (advisor) ; Doležalová, Irena (referee) ; Vojtěch, Zdeněk (referee)
Optimizing of Epilepsy Surgery in Paediatric Patients Abstract Epilepsy surgery represents an effective treatment of intractable focal epilepsy. The presented work aims to describe the state of the art and enhance diagnostic and therapeutic algorithm in paediatric patients. The ultimate goal is to improve the outcome of surgeries. The work depicts the evolution of the paediatric epilepsy surgery program in Motol Epilepsy Center over the course of years 2000-2017. Complexity of patients (younger age, epileptogenic zone in proximity of eloquent cortex, multifocal MRI findings) and surgeries (hemispherotomy) alike increased over time. However, the outcomes in terms of postoperative seizure-freedom and complications remained stable. Cognitive abilities of patients improved by 9.1 IQ/DQ points one year after surgery. Patients with preexisting intellectual deficit reached the most significant increase. We developed a novel paradigm of intraoperative cortical electrical stimulation mapping. Furthermore, we introduced a technique employing visual detection of SEEG electrodes during the surgery. These procedures aim to achieve a complete resection while avoiding complications. We developed and standardized Czech versions of questionnaires IPES a QOLIE-AD-48 assessing quality of life in children with epilepsy. We...
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Rehabilitation of Pediatric Patients After Neurosurgical Removal of Epileptogenic Zone
Růžková, Anna ; Zounková, Irena (advisor) ; Kudr, Martin (referee)
In its theoretical part this bachelors thesis "Rehabilitation of Pediatric Patients after Neurosurgical Removal of Epileptogenic Zone" concludes knowledge about epilepsy and its treatment, epilepsy surgery, medical rehabilitation used for neurological diseases and relation between epilepsy and sport. The research of literature concerning these topics was done. The second part of thesis consists of case report, which summarizes the process of postoperative rehabilitation in pediatric patient after hemispherectomy done at the Department of Neurosurgery, 2nd Faculty of Medicine and Motol University Hospital. Thesis evaluates the effect of rehabilitation procedures after the resection of the epileptogenic zone. Tests used for objective evaluation of motor functions were Gross Motor Function Measure - 88, Barthel Index and Box and Blocks Test.
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A practical value of different intraoperative electrophysiological methods in pediatric epilepsy surgery patients
Leško, Róbert ; Kršek, Pavel (advisor) ; Netuka, David (referee) ; Doležalová, Irena (referee)
Epilepsy, as the most common chronic neurological disease, affects a significant part of population (0.5-1%). Drug resistant epilepsy has a significant negative effect on the quality of life, psychiatric comorbidities, neurocognitive performance and the risk of SUDEP in children. Therefore, resective epilepsy surgery, the only curative treatment of this condition, can fundamentally reverse this unfavorable prognosis. An inevitable prerequisite for a good postoperative result is complete removal of the epileptogenic zone (EC) and preservation of eloquent areas (EC). At present, even with improving and new preoperative non-invasive methods, we don't have an exclusive diagnostic method for theirs delineation. The aim of this PhD study is to assess benefit of individual intraoperative electrophysiological (iEF) methods in pediatric patients with focal intractable epilepsy. The first study evaluates the importance of intraoperative electrocorticography (iECoG) in the localization of EZ. The study proved that iECoG serves as a reliable tool to guide surgical resection and may predict results of epilepsy surgery. iECoG-based modification of surgical plan is not associated with increased risk of significant complications. The second presented study analyzed the contribution of intraoperative electrical...
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