Consensus on pediatric epilepsy Che up surgery for young children:an investigation by the China Association Against Epilepsy task force on epilepsy surgery

Researchers have widely acknowledged the therapeutic value of epilepsy surgery for drug-resistant epilepsy.None-theless,there is a substantial gap in the surgical treatment for appropriate candidates owing to several factors,particularly in the population of young children.To standardize the protocols of preoperative evaluation and sur-gery of young children for epilepsy surgery,the China Association Against Epilepsy has appointed an expert task force to standardize the protocols of preoperative evaluation and surgery in pediatric epilepsy patients.It adopted the modifed Delphi method and performed two rounds of surveys through an anonymous inquiry among 75 experts from four subgroups including pediatric neurologists,epileptologists,pediatric epilepsy surgeons,and functional neurosurgeons.The survey contents contained:(1)the participants,comprising children aged≤6 years;(2)adopted DRE definition proposed by the International League Against Epilepsy in 2010;and(3)investigated epilepsy surgery,principally referring to curative epilepsy surgeries.The neuromodulation therapies were excluded because of the differences in treatment mechanisms from the above-mentioned surgeries.According to the Delphi process,a con-sensus was achieved for most aspects by incorporating two rounds of surveys including preoperative assessment,sur-gical strategies and techniques,and perioperative and long-term postoperative management,despite controversial opinions on certain items.We hope the results of this consensus will improve the level of surgical treatment and man-agement of intractable epilepsy in young children.

Three cases of paroxysmal alien limb phenomena due to epileptic seizures and review of literatures

Background:The alien hand phenomenon(AHP)is a rare disorder of involuntary limb movement together with a loss of sense of limb ownership.AHP occurs as a consequence of frontal,callosal,or posterior cerebral lesions.To characterize the phenomenon of AHP,three patients with paroxysmal AHP were described and proved to be focal seizures by using video-EEG monitoring.Method:Clinical history of 3 epileptic patients with AHP was collected.EEG and MRI were performed in each patient.One patient completed EEG monitoring and postoperative pathological examination.We also review the recent literatures and summarize the characteristics,types and hypothetic mechanisms of epileptic AHP.Results:Case 1 had AHP of the left arm followed by the left arm convulsion or AHP only.MRI imaging showed a lesion in the posterior parietal lobe.After complete resection of the lesion,he remained seizure free for 1.5 years.Cases 2 and 3 had AHP and convulsion.The three cases did not have auto-motor signs,so they were identified to be the posterior type of APH.Conclusions:The mechanism underlying AHP remains poorly.understood.Currently,little is known for the epileptic paroxysmal AHP,a quite rare form of AHP.AHP can be represented before or immediately after convulsion,or be represented by the paroxysmal symptom only.