Epilepsy Surgical Treatment - Northeast Regional Epilepsy Group
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Transcript Epilepsy Surgical Treatment - Northeast Regional Epilepsy Group
Epilepsy Surgery
E Feoli MD
North East Regional Epilepsy Group
2012
Comprehensive
Epilepsy
Center
Referrals
Evaluation:
●History/Exam
●EEG
●Imaging
Controlled
Not Controlled
Video-EEG
Non-epileptic
Events
Refer
Epilepsy
Medical
Management
Surgical
Management
The Poorly Controlled, Intractable
Seizure Patient
Despite medical management, patient
continues to have frequent, debilitating
seizures
Commonly on polytherapy (more than one
medication)
Candidates for Epilepsy
Surgery
Persistent seizures after initial attempts at
treatment (at least 2 appropriate AEDs at
reasonable doses)
Impaired quality of life due to ongoing
seizures
For focal resection: single seizure focus that
can be safely removed
Palliative procedures: corpus callosotomy,
subpial transections, VNS, others
Epilepsy Surgery
To determine where the seizures are coming
from
Video-EEG monitoring
MRI
MRS:
PET:
SPECT:
Goals of Video-EEG Monitoring
Epilepsy vs. nonepileptic events
Characterize epilepsy
type
Pre-surgical evaluation
FOCAL EPILEPSY
EEG Slide
Fp1-F7
F7-FT9
FT9-T7
T7-P7
P7-O1
Fp2-F8
F8-FT0
FT0-T8
T8-P8
P8-O2
FT9-FT0
A1-A2
Fp1-F3
F3-C3
C3-P3
P3-O1
Fp2-F4
F4-C4
C4-P4
P4-O2
ECG-RF
ECG-RF
SaO2(%) 0
0
0
0
0
HR(bpm)
0
0
0
0
Comment
0
spike
0
0
99-10-31/ROUTINE
0
0
0
0
0
0
0
0
Fp1-F7
F7-FT9
FT9-T7
T7-P7
P7-O1
Fp2-F8
F8-FT0
FT0-T8
T8-P8
P8-O2
FT9-FT0
A1-A2
Fp1-F3
F3-C3
C3-P3
P3-O1
Fp2-F4
F4-C4
C4-P4
P4-O2
ECG-RF
SaO2(%) 0
0
0
0
0
0
0
0
0
0
HR(bpm)
0
0
0
0
0
0
0
0
0
Comment
0
Brain MRI
MRI
MRI
SPECT SCAN
PET SCAN
Epilepsy Surgery
To make sure that it is safe
Wada test: to study speech and memory
Neuropsychological testing: mental functions (IQ,
memory, attention) and personality assessment
Psychological evaluation
Ophthalmologic evaluation
Epilepsy Surgery
Some cases in which the localization is not
clear or where function could be affected will
require INVASIVE ELECTRODES
Depth electrodes
Subdural electrodes
Subdural Electrodes
Types of Epilepsy Surgery
Temporal Lobectomy
Extratemporal
Resections
Hemispherectomy
Corpus Callosotomy
Outcome after epilepsy surgery
Anterior temporal lobectomy
Neocortical resection
With lesion: 50-80% seizure free
Without lesion: 30-50% seizure free
Hemispherectomy
70-80% seizure free
Significant improvement
Corpus Callosotomy
Significant improvement for drop attacks
Complications of surgery
Low rate of
complications
Infections
Bleeding
Anesthesia
Function
Vagus Nerve Stimulator (1997)
Intractable epilepsy patient without focus or desires
interim step before epilepsy surgery
Goal is to reduce amount/severity of seizures vs. cure
Device surgically implanted in left chest/axilla area
Coils around left vagus nerve
Stimulation is automatic; patient can additionally
stimulate device if aura
VNS Therapy
VNS: <10% seizure free,
30-50% with at least 50% seizure decrease,
more with lesser improvement; effects on
seizure severity?
Deep Brain Stimulation (DBS)
Neuropace
Conclusion
-Not all patients with refractory epilepsy are
surgical candidates.
-Patients with FOCAL refractory epilepsy
are candidates for surgery.
-Multiple steps are required before your
doctor concludes that you are a surgical
candidate.
-
Conclusion
You might be a good surgical candidate
however a RESECTIVE procedure
might not be possible, due to the
proximity o the seizure focus to
“eloquent cortex”
Thank you