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Aim Vagus nerve stimulation (VNS) is a well-known and increasingly common therapy. However, efficacy may differ depending on the type of epilepsy. In this study, we aimed to investigate and compare the efficacy and safety of VNS therapy in different types of epilepsy. Material and methods Patients, who were implanted with VNS between the years 2005 and 2020, were retrospectively included in the study. Age, gender, age at seizure onset, epilepsy types, VNS implantation year, replacement year, pre and post-VNS seizure frequency, number of responders, number of antiseizure medication and adverse events were recorded. Results In total, 41 patients were included in the study. The number of patients with focal epilepsy was 21 (51.2%). 10 patients (24.4%) had generalized epilepsy and 10 patients (24.4%) had "combined generalized and focal epilepsy" (Lennox-Gastaut, Dravet syndrome). The Pre-VNS median seizure frequency was 1.5/day in the focal group, 0.6/day in the generalized group and 6/day in the combined group. Seizure frequencies dropped to 0.3/day in the focal group, 0.2/day in the generalized group and 3.0/day in the combined group at the 12th month after VNS (p 0.001, p=0.004, p 0.001). The response rate was found to be 68.3% at the 12th month after VNS. The number of antiseizure medications was decreased from 3.6/day to 3.1/day at the 12th months after VNS (p 0.001). Two patients\' (4.9%) VNS therapy was discontinued due to adverse events. Conclusion The study indicates that VNS therapy is safe and effective in focal, generalized and combined epilepsy types. Despite having a low seizure freedom rate, VNS is a good alternative treatment option for patients who for any reason are not candidates for resective surgery.

AIM Cerebral cavernous malformations (CCM) are the second most common type of vascular malformations and also regarded as highly epileptogenic lesions if they involve the cortex. We present one of the largest retrospective cavernoma related epilepsy (CRE) studies which include divergent supratentorial locations operated and followed up at least 2 years. We also investigated the factors affecting the seizure outcome. MATERIAL AND METHODS This study includes 56 patients with drug-responsive (40) and drug-resistant (16) CRE who underwent resective surgery. Age at seizure onset, age at surgery, gender, duration of epilepsy, seizure frequencies/type before and after treatment, EEG and brain MRI findings, prescribed AEDs, preoperative and post-operative neurological status, histopathological diagnosis, post-operative seizure outcomes and surgical information were documented. RESULTS The average follow-up period was 69.6 months (range 24-216 months). The seizure outcome was assessed according to Engel's classification at the last follow-up. Engel class I was achieved in 53 patients (95%); there was one patient at class II and two patients at class III. All patients in the drug-responsive group were at Engel class I after the surgery, while all patients at Engel classes II and III were in the drug-resistant patient group. This clearly shows that there were better outcomes in DRP group (p 0.01). Neither the locations of cavernomas nor the duration of epilepsy had any impact on seizure outcome (p 0.05). CONCLUSION An earlier surgical intervention may prevent the patients from becoming drug-resistant such that their chances of being seizure free after surgery increase.

Aim Surgery for epilepsy is a significant treatment alternative with favorable outcomes in the pediatric age group. In this study we present the surgical outcomes of pediatric population referred to our center. Material and methods The clinical data of 126 patients (≤18 years) with lesional partial epilepsies operated in our center between 1995- 2011 were evaluated retrospectively. Parameters investigated were gender, age at seizure onset, duration of epilepsy, etiology, type and location of operation and outcome. Seizure outcome was classified according to Engel's classification. Results The study group consisted of 70 males (55,6%) and 56 females (44.4%). The most common etiology was malformation of cortical development followed by tumors and hippocampal sclerosis. Overall 73.8% of patients had Engel I, 13.5% Engel II and 11.9% Engel III+IV postoperative seizure outcome. Conclusion The results of our pediatric patients who underwent surgery were similar to previous reports in the literature. The seriousness of the clinical picture should tempt physicians to refer the patients as soon as possible to avoid long term complications like epileptic encephalopathies and the side effects of antiepileptic drugs during the development of the young brains.

AIM Awake craniotomy (AC) with electrical cortical stimulation has become popular during the last ten years although the basic principles were introduced almost 50 years ago. The aim of this paper is to share with the readers our experience in 25 patients who underwent AC with electrical stimulation. MATERIAL AND METHODS Twenty-five patients who underwent AC between 2010 and 2013 are the subjects of this paper. All patients were diagnosed with intraaxial lesions involving the functional area itself or very close to it by preoperative imaging. During surgery, the functional area was demonstrated by cortical electrical stimulation and resection aimed to preserve it in order to avoid an irreversible functional deficit. RESULTS Total resection was possible in 80% while in 20% subtotal resection had to be performed because of involvement of the functional area itself. The neurological complication rate was found to be 16% (4 patients) and all were transient. No complication regarding anesthesia was noted. CONCLUSION Awake craniotomy in selected patients is very effective, safe and practical for supratentorial lesions close to the eloquent area. Complications related to the surgery itself are uncommon and general anesthesia is avoided. The hospital stay including the intensive care unit is short which makes it very economical surgical procedure.

Surgery is a treatment option for medically intractable epilepsy patients. Abnormalities in regional cerebral glucose metabolism, as identified by 18-fluorodeoxyglucose positron emission tomography (FDG-PET) have predictive prognostic value in evaluating the outcome of epilepsy surgery. This study investigated the efficacy of FDG-PET for delineation of the epileptogenic zone (EZ) by comparing its consistency with other diagnostic tools and surgical outcome.We analyzed the results of 121 consecutive patients evaluated for epilepsy surgery. FDG-PET results were crosschecked with magnetic resonance imaging (MRI) and electroencephalography (EEG) results, as well as postoperative outcome and pathology.FDG-PET findings of 75 patients (62 %) were concordant with MRI (Mc-Nemar-χ2 test p=0.024, Kappa=0.22). Further, the PET findings were consistent with EEG, and was statistically significant, according to Post-hoc test, in temporal epilepsy (TLE) group (χ2=8.21 P=0.04). Both investigations revealed localizing information in 56 (46.2%) patients. Twenty-six (72.2%) MRI-negative patients had hypometabolism on PET. The pathology of the 10 PET-negative patients was 5 cases of mesial temporal sclerosis, 2 cortical dysplasia, 2 gliosis and one tumor. Seven (70%) of these patients' lesions originated from the temporal lobe. FDG-PET had correctly predicted the EZ in 37 (86%) of 43 patients who underwent surgery.FDG-PET results may not be strongly associated with EZ but represent an additional tool in delineation of EZ during the noninvasive phase of presurgical evaluation.

Aim Surgery is a treatment option for medically intractable epilepsy patients. Abnormalities in regional cerebral glucose metabolism, as identified by 18-fluorodeoxyglucose positron emission tomography (FDG-PET) have predictive prognostic value in evaluating the outcome of epilepsy surgery. This study investigated the efficacy of FDG-PET for delineation of the epileptogenic zone (EZ) by comparing its consistency with other diagnostic tools and surgical outcome. Material and methods We analyzed the results of 121 consecutive patients evaluated for epilepsy surgery. FDG-PET results were crosschecked with magnetic resonance imaging (MRI) and electroencephalography (EEG) results, as well as postoperative outcome and pathology. Results FDG-PET findings of 75 patients (62 %) were concordant with MRI (Mc-Nemar-χ2 test p=0.024, Kappa=0.22). Further, the PET findings were consistent with EEG, and was statistically significant, according to Post-hoc test, in temporal epilepsy (TLE) group (χ2=8.21 P=0.04). Both investigations revealed localizing information in 56 (46.2%) patients. Twenty-six (72.2%) MRI-negative patients had hypometabolism on PET. The pathology of the 10 PET-negative patients was 5 cases of mesial temporal sclerosis, 2 cortical dysplasia, 2 gliosis and one tumor. Seven (70%) of these patients' lesions originated from the temporal lobe. FDG-PET had correctly predicted the EZ in 37 (86%) of 43 patients who underwent surgery. Conclusion FDG-PET results may not be strongly associated with EZ but represent an additional tool in delineation of EZ during the noninvasive phase of presurgical evaluation.

In utero irradiation models induce diffuse neuronal damage. Experimental studies have shown that hyperthermia induced seizures are easily elicited and have high mortality accompanied by neuronal loss. Neuronal damage and loss are the results of cell death coupled with cortical development in altered cellular development. The aim of the study was to investigate the changes in hippocampus that was exposed to irradiation and hyperthermia.Four groups were studied: 1) The irradiation group was exposed to 225 cGy irradiation on the 17th gestational day; 2) The hyperthermia group was exposed to hyperthermia on the 10th postnatal day; 3) The hyperthermia plus irradiation group was exposed to in utero irradiation and postnatal hyperthermia; 4) The control group was sham operated. Animals were examined 3 and 6 months later.The hippocampus was atrophic with neuronal loss in CA regions and ectopic neurons were in irradiation group. Severe damage with the most atrophy was demonstrated in all regions of the irradiation plus hyperthermia group. In long term, damage was severe in all groups.This study demonstrated more damage in hippocampi exposed to both irradiation and hyperthermia that may be taken as an evidence for the double hit hypothesis in the development of hippocampal damage.