Epilepsy surgery
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Epilepsy surgery | |
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epileptology |
Epilepsy surgery involves a
First line therapy for epilepsy involves treatment with anticonvulsive drugs, also called antiepileptic drugs. Most patients will respond to one or two different medication trials. The goal of this treatment is the elimination of seizures, since uncontrolled seizures carry significant risks, including injury and sudden death. However, in up to one third of patients, medications alone do not eliminate seizures, and/or cause
Generally, surgery is considered in patients whose seizures cannot be controlled by adequate trials of two different medications. Epilepsy surgery has been performed for more than a century, but its use dramatically increased in the 1980s and 1990s, reflecting its efficacy in selected patients.[2][3]
Evaluation
The evaluation for epilepsy surgery is designed to locate the "epileptic focus" (the location of the epileptic abnormality) and to determine if resective surgery will affect normal brain function. The definition of the epileptogenic zone has a fundamental role in determining the boundaries of the area that needs to be removed in order to achieve seizure freedom but also in order not to harm “eloquent cortex” (damage to this area produces neurological deficit). As the localization technology has improved, the definition of the epileptogenic zone has expanded to comprise a larger area of the brain than before.
If noninvasive testing was inadequate in identifying the epileptic focus or in distinguishing the surgical target from normal brain tissue and function, then Long-term video-EEG monitoring with the use of intracranial electrodes may be required for evaluation. Brain mapping by the technique of cortical electrical stimulation or Electrocorticography are other procedures used in the process of invasive testing for certain patients.[7][8]
Once the epilepsy focus is located, the specific surgery involved in treatment is decided on. The type of surgery depends on the location of the seizure focal point. Surgeries for epilepsy treatment include, but are not limited to, the following types: temporal lobe resection, hemispherectomy, ground temporal and extratemporal resection, parietal resection, occipital resection, frontal resection, extratemporal resection, and
Hemispherectomy
Temporal lobe resection
Temporal lobe resection acts as a treatment option for patients with
The surgery has produced successful outcomes, controlling seizures in 65 percent of temporal lobe epilepsy patients. Follow-up studies suggest that the procedure also has produced positive long-term effects that illustrate 63 percent of patients still remaining seizure-free.[14] Although the procedure produces positive outcomes for patients regarding seizure control, the surgery can also produce negative outcomes such as memory impairment. Impairment depends on the hemisphere of resection; temporal lobe resection of the dominant hemisphere often causes verbal memory impairment while temporal lobe resection of the non-dominant hemisphere often causes visual memory impairment.[15]
Extratemporal lobe resection
Extratemporal lobe resection acts as a treatment option for patients with extratemporal epilepsy, or epilepsy patients whose seizure focus is outside of the temporal lobe, and stems from either the
Tumor Resection
If a benign or malignant brain tumor is suspected to be the cause of seizure activity, surgical removal of the tumor may be indicated. The approach and technique is case-dependent. One study of supratentorial brain tumors in children less observed a dramatic reduction in the severity and frequency of seizures at one and four year follow-up.[18]
Laser Ablation
See ablative brain surgery.[19]
See also
References
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- ^ "Epilepsy and Extratemporal Cortical Resection". WebMD. Retrieved 23 April 2015.
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- ^ "Laser Ablation Surgery for Epilepsy". Texas Children's Hospital. Archived from the original on 10 June 2012. Retrieved 8 October 2016.