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epilepsy_surgery

Epilepsy surgery

see also Pediatric Epilepsy Surgery.

Indications

Epilepsy surgery indications.

Pre-surgical evaluation

Epilepsy surgery pre-surgical evaluation.

Techniques

Resective epilepsy surgery.

Hemispherectomy.

Magnetic resonance guided laser induced thermal therapy for epilepsy.

Temporal lobe epilepsy surgery

Vagus nerve stimulation for drug resistant epilepsy.


see Epilepsy surgery in India.

The current practice under which patients with refractory epilepsy are surgically treated is based mainly on the identification of specific cortical areas, mainly the epileptogenic zone, which is believed to be responsible for generation of seizures. A better understanding of the whole epileptic network and its components and properties is required before more effective and less invasive therapies can be developed.

Epilepsy surgery is constantly researching for new options for patients with refractory epilepsy.

see Magnetic resonance guided laser induced thermal therapy for epilepsy

Despite significant underutilization of surgical treatment for drug-resistant epilepsy, no studies have quantified patient desire for surgery within a representative population.

An online survey was administered to all clients connected with a core epilepsy community access center. It obtained information about demographics, clinical characteristics, knowledge of epilepsy surgery, and interest in receiving surgery before and after receiving risk/benefit information about it.

Of 118 potential respondents, 48 (41%) completed the questionnaire, of which 67% had failed more than two AEDs and 78% experienced seizures in the past year. Eleven ( 26%) were uninterested in receiving surgery at baseline, and this decreased significantly to 7 (16%) following knowledge translation regarding the benefits (p = 0.001). Significance was lost with subsequent complication rate information despite fewer respondents still being uninterested compared to baseline (20% vs. 26%). Having experienced seizures within the past month was correlated with being interested in or undecided regarding surgery at baseline and following all steps of knowledge translation. Subjects had conservative views regarding the benefits of surgery and largely overestimated the risks.

A significant portion of those with active epilepsy in the community do not desire surgical treatment. Passive knowledge translation regarding the risks and benefits enhanced optimistic attitudes and mobilized interest within a subset of participants. Preexisting views regarding the risks of surgery were exaggerated, and analysis suggests that these views can be modified with information about the benefits of surgery. However, exaggerated risk perceptions return following crude descriptions of the risks, underlying the importance of sensitive counseling from primary care physicians 1).


In Epilepsy surgery where resective surgery is not indicated, deep brain stimulation (DBS) may be an effective alternative. The majority of available literature targets the thalamic nuclei (anterior; centromedian), subthalamic nucleus, hippocampus, and cerebellum.

Data show DBS may be a safe and effective treatment option for refractory epilepsy 2).

Surgery is a safe and effective option for some patients, however the opportunity exists to develop less invasive and more effective surgical options. To this end, multiple minimally invasive, image-guided techniques have been applied to the treatment of epilepsy. These techniques can be divided into thermoablative and disconnective techniques. Each has been described in the treatment of epilepsy only in small case series. Larger series and longer follow up periods will determine each option's place in the surgical armamentarium for the treatment of refractory epilepsy but early results are promising 3).

Outcome

see Epilepsy Surgery outcome.

Neuromodulation

Several palliative neuromodulation treatment modalities are currently available for adjunctive use in the treatment of medically intractable epilepsy. Over the past decades, a variety of different central and peripheral nervous system sites have been identified, clinically and experimentally, as potential targets for chronic, nonresponsive therapeutic neurostimulation. Currently, the main modalities in clinical use, from most invasive to least invasive, are anterior thalamus deep brain stimulation, vagus nerve stimulation, and trigeminal nerve stimulation. Significant reductions in seizure frequency have been demonstrated in clinical trials using each of these neuromodulation therapies 4).

see Vagus nerve stimulation for drug resistant epilepsy.

Books

Engel J Jr, Van Ness PC, Rasmussen T, Ojemann LM: Outcome with respect to epileptic seizures, in Engle J Jr (ed): Surgical Treatment of the Epilepsies, ed 2. New York: Raven Press, 1993, pp 609–621

Case series

Epilepsy surgery case series.

References

1)
Zuccato JA, Milburn C, Valiante TA. Balancing health literacy about epilepsy surgery in the community. Epilepsia. 2014 Sep 23. doi: 10.1111/epi.12791. [Epub ahead of print] PubMed PMID: 25251908.
2)
Klinger NV, Mittal S. Clinical efficacy of deep brain stimulation for the treatment of medically refractory epilepsy. Clin Neurol Neurosurg. 2015 Nov 14;140:11-25. doi: 10.1016/j.clineuro.2015.11.009. [Epub ahead of print] Review. PubMed PMID: 26615464.
3)
Bandt SK, Leuthardt EC. Minimally Invasive Neurosurgery for Epilepsy Using Stereotactic MRI Guidance. Neurosurg Clin N Am. 2016 Jan;27(1):51-8. doi: 10.1016/j.nec.2015.08.005. Epub 2015 Oct 24. Review. PubMed PMID: 26615107.
4)
Krishna V, Sammartino F, King NK, So RQ, Wennberg R. Neuromodulation for Epilepsy. Neurosurg Clin N Am. 2016 Jan;27(1):123-131. doi: 10.1016/j.nec.2015.08.010. Epub 2015 Oct 24. Review. PubMed PMID: 26615114.
epilepsy_surgery.txt · Last modified: 2020/02/20 13:04 by administrador