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Dworetzky, Barbara

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Dworetzky

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Barbara

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Dworetzky, Barbara
Author's Publications: search.filters.isAuthorOfPublication.1b5c3796-236d-45dc-b33c-706118645d91

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    Recurrent Epileptic Auras As a Presenting Symptom of Alzheimer’s Disease
    (Frontiers Media S.A., 2017) Sarkis, Rani; Willment, Kim C.; Gale, Seth; Dworetzky, Barbara
    Seizures are a common co-morbidity during the course of Alzheimer’s disease (AD) and in a subset of patients may be one of the presenting symptoms. In this case series, we highlight three patients with recurrent medically refractory epileptic auras whose work up ultimately lead to the diagnosis of AD. All three patients underwent prolonged EEG, serial neuropsychological testing, FDG-PET, cerebrospinal fluid (CSF) AD biomarkers, and MRI. CSF biomarkers were particularly helpful in two cases. These cases highlight the importance of having a high index of suspicion for AD in new onset “idiopathic” epilepsy in the elderly.
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    Outcomes after discontinuation of antiepileptic drugs after surgery in patients with low grade brain tumors and meningiomas
    (Springer Nature, 2012) Das, Rohit R.; Artsy, Elinor; Hurwitz, Shelley; Wen, Patrick; Black, Peter; Golby, Alexandra; Dworetzky, Barbara; Lee, Jong
    Low grade tumors are associated with a high risk of seizures. Prolonged use of antiepileptic drugs (AEDs) is associated with morbidity. Determining which patients can safely discontinue AEDs perioperatively is difficult. We examined patients with low grade supratentorial brain tumors to determine characteristics of patients who underwent AED withdrawal. A retrospective chart review was performed in patients who underwent resection between 1/1/2004 and 12/31/2005 at a single center. Data were collected regarding the use of postoperative AEDs, occurrence of postoperative seizures, and patient/tumor characteristics. We examined 169 patients with a median follow-up of 3.1 years. AEDs were withdrawn or never started in 111 patients; post-withdrawal seizures occurred in 11 (9.9%). The rate was similar between meningiomas and primary brain tumors. No independent risk factors for post-withdrawal seizures were found. Of 58 patients whose AEDs were not withdrawn, postoperative seizures occurred in 28 (48%). Predictors of AED continuation included existence of preoperative seizures, temporal tumor location, tumor recurrence, incomplete resection, and male sex. The decision to continue AEDs was predictive for postoperative seizures even after controlling for known risk factors. Although clinicians are able to identify patients at high risk for postoperative seizures, treatment with AEDs is ineffective in many patients.
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    Current dipole orientation and distribution of epileptiform activity correlates with cortical thinning in left mesiotemporal epilepsy
    (Elsevier BV, 2010) Reinsberger, Claus; Tanaka, Naoaki; Cole, Andrew J.; Lee, Jong Woo; Dworetzky, Barbara; Bromfield, Edward B.; Hamiwka, Lorie; Bourgeois, Blaise; Golby, Alexandra; Madsen, Joseph; Stufflebeam, Steven
    To evaluate cortical architecture in mesial temporal lobe epilepsy (MTLE) with respect to electrophysiology, we analyze both magnetic resonance imaging (MRI) and magnetoencephalography (MEG) in 19 patients with left MTLE. We divide the patients into two groups: 9 patients (Group A) have vertically oriented antero-medial equivalent current dipoles (ECDs). 10 patients (Group B) have ECDs that are diversely oriented and widely distributed. Group analysis of MRI data shows widespread cortical thinning in Group B compared with Group A, in the left hemisphere involving the cingulate, supramarginal, occipitotemporal and parahippocampal gyri, precuneus and parietal lobule, and in the right hemisphere involving the fronto-medial, -central and -basal gyri and the precuneus. These results suggest that regardless of the presence of hippocampal sclerosis, in a subgroup of patients with MTLE a large cortical network is affected. This finding may, in part, explain the unfavorable outcome in some MTLE patients after epilepsy surgery.