Publications by authors named "Ahsan N Moosa"
Article Synopsis
- The 2023 American Epilepsy Society Annual Course focused on the importance of timing in evaluating and treating epilepsy, especially for vulnerable populations and those facing health disparities.
- The course covered a wide range of topics, including gaps in epilepsy care, behavioral health optimization, seizure forecasting, and treatment timing for various seizure types and conditions.
- Key discussions included the role of neuromodulation versus surgery, strategies for autoimmune-associated epilepsy, dietary therapy, and leveraging new biomarkers in collaboration with neuropsychological outcomes.
To conduct a systematic review of the literature regarding rates and predictors of favorable seizure outcome after resective surgery for epileptic spasms (ES) in pediatric patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed. We searched PubMed, EMBASE, and Cochrane CENTRAL for articles published on the prevalence or incidence of epileptic spasm since 1985.
View Article and Find Full Text PDFPupillary changes can be an important semiologic feature in focal epilepsy. Though the subcortical networks involving pupillomotor function have been described, cortical generators of pupillary dilation and constriction in humans are not well known. In this report, we describe a case of pupillary constriction occurring during seizures in a patient with drug resistant focal epilepsy.
View Article and Find Full Text PDFArticle Synopsis
- Epileptic spasms are a type of seizure found in infants and young children, often linked to a syndrome that can cause developmental delays and declines due to abnormal brain activities seen in EEGs.
- Early detection and treatment of these spasms are crucial to improving children's outcomes, with hypsarrhythmia patterns playing a key role in diagnosis.
- Some patients may have treatable causes for their spasms that can be identified with brain imaging, though surgical decisions may not always require invasive EEG monitoring.
Objective: The risk of hydrocephalus following hemispherectomy for drug resistant epilepsy (DRE) remains high. Patients with pre-existing hydrocephalus pose a postoperative challenge, as maintaining existing shunt patency is necessary but lacks a clearly defined strategy. This study examines the incidence and predictors of shunt failure in pediatric hemispherectomy patients with pre-existing ventricular shunts.
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- - The study focuses on pediatric patients who undergo hemispherectomy surgery for intractable epilepsy and examines the complication of hydrocephalus that can arise post-surgery, highlighting the need to understand its mechanisms better for improved patient care.
- - A retrospective review of 204 patients from the Cleveland Clinic looked at various factors like demographics, surgical history, and complications to identify those contributing to hydrocephalus, with 14% of patients developing the condition post-operation.
- - Findings indicated that 46% of patients with hydrocephalus experienced symptoms within 90 days post-surgery, and certain factors, like postoperative aseptic meningitis, were significantly linked to the development of hydrocephalus.
Article Synopsis
- The study aimed to identify factors that influence successful epileptogenic zone (EZ) identification and seizure freedom in pediatric patients with drug-resistant epilepsy who received stereoelectroencephalography (SEEG).
- Researchers analyzed data from 101 patients under 18 years old treated between July 2009 and June 2020, excluding those with previous failed surgery.
- Results showed that older onset of epilepsy and suspected developmental lesions increased the likelihood of EZ identification, while having an MRI lesion positively affected seizure freedom after surgical treatment.
Background: Anti-NMDAR encephalitis is a leading cause of autoimmune encephalitis in children. Untreated disease can lead to long-term neurological disability.
Case Report: We present siblings with pediatric-onset anti-NMDAR encephalitis.
Objective: We aimed to assess the treatment response of infantile-onset epileptic spasms (ES) in CDKL5 deficiency disorder (CDD) vs other etiologies.
Methods: We evaluated patients with ES from the CDKL5 Centers of Excellence and the National Infantile Spasms Consortium (NISC), with onset from 2 months to 2 years, treated with adrenocorticotropic hormone (ACTH), oral corticosteroids, vigabatrin, and/or the ketogenic diet. We excluded children with tuberous sclerosis complex, trisomy 21, or unknown etiology with normal development because of known differential treatment responses.
Article Synopsis
- The study looked at how surgery helps people with epilepsy who don’t get better with medication, focusing on long-term effects over many years.
- They found that a lot of patients had fewer seizures and some even became seizure-free, with many feeling better after a while even if they weren’t better right away.
- Overall, the results showed that even if someone still has seizures after surgery, they can still experience significant improvements over time.
Article Synopsis
- The study looked at EEG (brain wave) changes in patients who had part of their brain removed (hemispherectomy) and were not having seizures anymore.
- Researchers collected information on these patients before and after the surgery to see how their brain activity changed.
- Most patients still had some unusual brain wave patterns after the surgery, but many were able to stop taking their seizure medications after a few years.
Electroclinical Features in Epilepsy Surgery Candidates With Epileptic Spasms.
J Clin Neurophysiol
November 2022
Electroclinical features in surgical candidates with epileptic spasms differ significantly from the other focal epilepsy phenotypes. EEG findings tend to be more diffuse and less localizing in children with epileptic spasms. These are illustrated with five case studies to highlight three different categories of findings on interictal and ictal EEG: lateralizing , nonlateralizing , and false lateralizing .
View Article and Find Full Text PDFBackground: CDKL5 deficiency disorder (CDD) is associated with refractory infantile onset epilepsy, global developmental delay, and variable features that include sleep, behavioral disturbances, and movement disorders. Current treatment is primarily symptom-based and informed by experience in caring for this population.
Methods: We describe medication and non-medication approaches to treatment of epilepsy and additional key neurologic symptoms (sleep disturbances, behavioral issues, movement disorders, and swallowing dysfunction) in a cohort of 177 individuals meeting criteria for CDD, 154 evaluated at 4 CDKL5 Centers of Excellence in the USA and 40 identified through the NIH Natural History Study of Rett and Related Disorders.
Article Synopsis
- Some kids who have had leukemia can also develop epilepsy, which is when your brain has seizures.
- In a study, 10 kids with leukemia showed two types of hard-to-treat epilepsy: Lennox-Gastaut syndrome and focal epilepsy.
- Kids with temporal lobe epilepsy showed good results after surgery, but other types of epilepsy didn't respond as well.
Background: To quantitatively evaluate the brain MRI morphological abnormalities in patients with cyclin-dependent kinase-like 5 deficiency disorder (CDD) on a group level and longitudinally.
Methods: We performed surface-based MRI analysis on high-resolution T1-weighted images on three CDD patients scanned at age of three years, and compared with 12 age- and gender-matched healthy controls. We further examined the longitudinal morphological changes in one patient with a follow-up of 5 years.
Article Synopsis
- Some patients with epilepsy don’t show anything abnormal on MRI scans, making it tough to treat them after surgery doesn’t work.
- This study looked at 56 of these patients and used special MRI techniques to find spots in the brain that might be causing seizures.
- They found that in some cases, these new spots matched with other tests, and in two patients who had more surgery, they became seizure-free.
Background And Purpose: Epilepsy surgery for medically refractory epilepsy secondary to cortical dysplasia in children poses special challenges. We aim to review the current available literature on the outcome after epilepsy surgery for cortical dysplasia in children and critically evaluate the prognostic predictors of outcome.
Methods: A comprehensive review of the literature was performed focusing on the outcome after epilepsy surgery for cortical dysplasia in children.
Purpose: To examine the long-term functional outcomes and their predictors using a patient/family centered approach in a cohort of children who had hemispherectomy. Functional outcome measures studied were the following: ambulation ability, visual symptoms, spoken language, reading skills, and behavioral problems.
Methods: We reviewed 186 consecutive children who underwent hemispherectomy between 1997 and 2009 at our center.
The spectrum of focal epileptogenic lesions and their clinical manifestations in children differ substantially from those seen in adults. In adults, mesial temporal sclerosis is the common lesion in surgical series; but in children, MTS is uncommon, and when it does occur, it exists frequently as dual pathology. The most common lesions in pediatric epilepsy surgery candidates are malformations of cortical development, developmental tumors, or encephalomalacia from infarction, hypoxia, trauma, or infection.
View Article and Find Full Text PDFObjective: Data on longitudinal seizure outcome after hemispherectomy in children are limited. This study explores the posthemispherectomy longitudinal seizure outcome and its predictors.
Methods: We reviewed 186 consecutive children who underwent hemispherectomy between 1997 and 2009 at our center.
Mutations in the smooth muscle-specific isoform of α-actin (ACTA2) cause vascular smooth muscle dysfunction leading to aortic aneurysm and moyamoya syndrome. A unique R179H mutation in ACTA2 has been reported to result in widespread smooth muscle dysfunction affecting vascular and extravascular smooth muscles. We report a 7-year-old girl with an ACTA2 R179H mutation manifesting with neonatal seizures due to multifocal infarcts, asymmetric motor deficits, global developmental delay, spasticity, congenital bilateral mydriasis, and a large patent ductus arteriosus.
View Article and Find Full Text PDFBackground: In patients with medically intractable epilepsy and diffuse unilateral hemispheric disease, functional or disconnective hemispherectomy is a widely accepted and successful treatment option. If recurrent seizures develop after disconnective hemispherectomy, management options become more complex and include conversion to anatomic hemispherectomy.
Objective: To present the outcomes of all patients undergoing reoperative hemispherectomy in 1 institution by 1 surgeon since 1998.