Epileptic Surgery

Question 0

The Work Up

Answer 0

History-Semology (what they describe) and physical exam (any paralysis)
Imaging
EEG
Only local seizures are candidates for surgery

Question 1

Prevelance

Answer 1

75% controlled with medication
5% chance of epileptic seizure in life
1.5 million with epileptic seizure
375,000 intractable epilepsy

Question 2

Imaging

Answer 2

CT Scan
MRI-better-medial temporal sclorsis, cortical dysplasia (cortical malformation), curvilinear constriction-bring in operting room.
EEG-Right temporal seizure, right side. Deep hippocampal. Left temporal seizure
Mathematical Dipole Model-Real time modelling to map spread of dipole on brain. Find where it comes from mathematically. Frontal lobe to temporal lobe. Potentially use to find where its coming from
Pet Scan-Functional imaging. Cancer-glucose eating. SISCOM-IV and electrodes. 10-15 secodns of starting seizure-inject radioactive isotope. Find originating place.
Depth Electrodes and Grid LEectrodes-blanket of electrodes on inside of brain (SEEG) 1mm of accuracy

Question 3

Awake craniotomy

Answer 3

Most common-temporal lobe dissection. Stimulate motor strip-see what happens.
Intraoperative Stimulation under local anaesthesia
Bipolar stimulation (ojemann stimulator) tech aspects
Mapping-motor, sensory, language.
Selective Amygdalohippocanpectomy-side of head. Trans-cortical-oliver
Only one side or else HM

Question 4

HM

Answer 4

Bilateral medial temporal dissection

Memory fucked

Question 5

Multiple Subpial Transection (MSI)

Answer 5

Landlau-Kleffner.

Cut fibres underneath every 5mm. Keep functions but cut connections

Question 6

Vagal Nerve Stimulator

Answer 6

Fires hen seizure is coming in order to reset electricity in the brain.
Has to be on left because right vagal nerve controls the heart

Question 7

Whats New?

Answer 7

Diffusion weighted imaging-functions shown functional MRI. Bold effect.
Brownian motion of water molecule-where are they moving faster? follow tracts of movement