Epileptic Surgery

Question 1

what is epilepsy described as?

Answer 1

fits, faints and funny turns

fits –> epileptic seizures
faints –> non-epileptic syncopal episods (subtle)
funny turns –> psychogenic attacks

epileptic seizures occur all the time for no specific cause or stimulus

Question 2

what are three examples of subtle seizures?

Answer 2

1. absence seizures –> subtle seizures that are often undetected
2. myoclonus seizures –> also subtle, associated with jerking movements (like what u do when ur sleeping) and it forms in kids
3. CPS (complex partial seizures) –> occurs at one area of the brain and does not spread across hemispheres … its more subtle and includes auras

Question 3

what are three examples of not so subtle seizures?

Answer 3

1. frontal lobe central
2. frontal lobe left
3. SMA (supplementary motor area)

these involve the motor areas of the brain and the frontal lobe central and frontal lobe left seizures don’t include the tiredness or sleepiness after the seizure is done (person resumes back to normal)

Question 4

what are two examples of non epileptic seizures?

Answer 4

1. spell

2. PNES (psychogenic non-epileptic seizure) –> cause mainly by stressors in life)

Question 5

What is the chance of having an epileptic seizure in your life?

Answer 5

5%

Question 6

what are the chances of your seizures being controlled with medication?

Answer 6

75%

Question 7

what is the most common cause of surgical epilepsy?

Answer 7

Mesial temporal sclerosis

Question 8

in what ways does an MRI help in surgical epilepsy and imaging used in detection?

Answer 8

MRI looks at specific areas of the brain like cortical dysplasia and shows shrunken gyruses and can do curvilinear reconstruction (digitally forming curvatures of the brain to get better reality and resolution)

Question 9

in what ways can an EEG be used to detect/localize seizures?

Answer 9

an EEG can show u which hemisphere and lobe the electrical activity started from (live) and can show when it progresses

using mathematical modules u can map where in the brain the EEG is coming from in real time

Question 10

what are some invasive methods of monitoring epilepsy?

Answer 10

used when invasive methods fails

includes depth electrodes (SEEG) and Grid electrodes

depth electrodes involve putting electrodes on side of the brain that seizure starts in .. the only downfall is risk of infection .. they are drilled in

grid electrodes is the same thing but they are on the surface of the brain

Question 11

What is awake craniotomy?

Answer 11

intraoperative stimulation under local anesthesia .. the patient is awake though

bipolar stimulation

mapping of areas such as the motor, sensory and language areas of the brain and stimulates parts of their brain to see what their functions are

Question 12

what are some areas of the brain that can be sensed out?

Answer 12

mainly done in the temporal lobe
but theres areas like where the thumb is located in the brain is on top of the lips and tongue

• also theres naming area: when its stimulated u can’t name things
• theres speech arrest area: when stimulated, patient stops talking
• theres seizure area –> when stimulated person gets a seizure
• theres tongue and lip sensation as well

Question 13

what is selective amygdalohippocampectomy?

Answer 13

seizures coming from hippocampus or amygdala areas have their amygdala and hippocampus removed selectively … these areas are suctioned out (burning)

Question 14

What is multiple subpial transection (MST)?

Answer 14

making small cuts in gyrus to prevent spreading of seizures… disruption of fibres at the top of the brain near the motor area