[show abstract][hide abstract] ABSTRACT: A 57-year-old-man treated with deep brain stimulation (DBS) of both subthalamic nuclei for advanced Parkinson disease developed a brain hemorrhage near the site of one of the DBS electrodes 9 months after implantation. The hemorrhage caused vertical diplopia from skew deviation. Examination also disclosed evidence of ipsiversive binocular torsion and a right head tilt, constituting an ocular tilt reaction (OTR). Fourteen months later, he was still symptomatic from diplopia. An OTR has not previously been reported as a delayed complication of DBS.
Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 12/2009; 29(4):286-8. · 1.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: Functional hemispherectomy is a surgical technique used to treat refractory epilepsies in the setting of extensive unilateral hemispheric lesions. Most series of hemispherectomies include mainly pediatric patients.
We report our series of four adult patients that have undergone functional hemispherectomy for their refractory epilepsy. Each one had a complete presurgical evaluation including video EEG, neuropsychological testing and anatomical and functional neuroimaging. In three of them, the epilepsy was secondary to a middle cerebral artery infarction. One patient had Rasmussen encephalitis.
After surgery, three patents have become completely seizure free (follow up 13-26 months). The fourth patient has had more than 75% reduction in seizure frequency. All of them have had significant improvement in their quality of life. Early complications included an isolated tonic-clonic generalized seizure (one patient), and status epilepticus in another patients related to infection and use of meropenem. Only one patient has presented hemianopia as a permanent neurological deficit after surgery.
Functional hemispherectomy is a good surgical option in the setting of large unilateral hemispheric lesions causing hemiparesis and intractable seizures, even in adult patients.