title: Epilepsy surgery in a liver-transplanted girl with temporal lobe epilepsy and hippocampal sclerosis following PRES with status epilepticus.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) with status epilepticus may occur after liver transplant. This may rarely lead to refractory epilepsy and hippocampal sclerosis (HS).
  
  
  METHODS
  We report the first case of epilepsy surgery in a liver-transplanted patient with refractory temporal lobe epilepsy. A 3-year-old girl underwent liver transplant for congenital biliary atresia. Four days after transplant she manifested PRES with status epilepticus, but she recovered within a couple of weeks. At the age of 5 years she started presenting complex partial seizures, that became refractory to antiepileptic drugs (AED), worsening psychosocial performances. The pre-surgical work-up identified a left HS and temporal pole alterations. A left antero-mesial temporal lobectomy was performed, leading to epilepsy remission and allowing AED withdrawal.
  
  
  CONCLUSIONS
  Drug-resistant temporal lobe epilepsy and HS may occur as sequelae of PRES with status epilepticus related to liver transplant and cyclosporine use. In this setting early epilepsy surgery may reduce the time of chronic exposure to AED and severe illness due to repeated seizures. This option might have additional advantages in the subgroup of epileptic patients with liver transplant, preserving the liver from the potential damage due to multiple AED trials and their interaction with commonly used immunosuppressant drugs.
authors.affiliation: Service of Paediatric Epileptology - Unit of Clinical Neurophysiology, Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: robertino.dilena@policlinico.mi.it.
authors.forename: Robertino
authors.initials: R
authors.lastname: Dilena
authors.affiliation: Service of Paediatric Hepatology, Department of Paediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nebbia
authors.affiliation: Service of Paediatric Hepatology, Department of Paediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fiorica
authors.affiliation: Service of Paediatric Hepatology, Department of Paediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Farallo
authors.affiliation: Service of Paediatric Hepatology, Department of Paediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Degrassi
authors.affiliation: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gozzo
authors.affiliation: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Pelliccia
authors.affiliation: Service of Paediatric Epileptology - Unit of Clinical Neurophysiology, Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Barbieri
authors.affiliation: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
authors.affiliation: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001656:Biliary Atresia / Q000601:surgery*; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D016031:Liver Transplantation; D054038:Posterior Leukoencephalopathy Syndrome; D011183:Postoperative Complications; D012598:Sclerosis; D013226:Status Epilepticus
chemical_list: D000927:Anticonvulsants
keywords: Epilepsy surgery; Hippocampal sclerosis; Liver transplant; Posterior reversible encephalopathy syndrome; Refractory epilepsy; Temporal lobe epilepsy