Epileptic Encephalopathy with CSWS in the Setting of a Unilateral Structural Brain Lesion Amenable to Resection
Clinical Scenario
This protocol addresses continuous spike and wave during slow wave sleep (CSWS) occurring in the context of a unilateral structural brain lesion — either a cortical malformation or a localised area of injury — that has been identified as amenable to surgical resection. The unilateral and focal nature of the underlying lesion defines the treatment pathway for this specific presentation.
Treatment Approach
For this scenario, the structured approach involves a surgical intervention directed at the structural lesion. Current evidence supports epilepsy surgery evaluation for children presenting with CSWS caused by a unilateral brain lesion amenable to resection. The complete protocol — including full eligibility criteria, procedural details, and decision algorithm — is available via the link below.
Treatment Goals
- Clinical improvement in neurocognitive function, seizure burden, or EEG findings
- At least 50% reduction in the sleep spike wave index (SWI) on post-treatment EEG compared to pre-treatment baseline
References
DOI: 10.1016/j.jpeds.2021.01.032
- Surgeries have typically included focal resection for cases of unilateral structural brain lesions (malformations or areas of injury) or multiple subpial transections, a procedure that has fallen out of favor as it was shown to be ineffective at resolving CSWS or enhancing cognitive outcomes or quality of life.
- Our data support recommendations made by prior authors that epilepsy surgery evaluation should be considered for children with CSWS caused by unilateral brain lesions amenable to resection.
- The clinical response was defined as clinical improvement in neurocognitive function, seizures, or the EEG after therapy as judged and documented in the medical record by the treating neurologist.
- The SWI response was defined by a 50% reduction in the sleep SWI when comparing the post- and pre-treatment EEGs.
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