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NEURO 210 > Lecture 17: Epilepsy Surgery > Flashcards

Lecture 17: Epilepsy Surgery Flashcards

1
Q

What was Gowers (1800’s) definition of epilepsy?

A

“fits, faints, and funny turns”

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2
Q

What are “fits”?

A

epileptic seizures

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3
Q

What are “faints”?

A

non epileptic syncopal episodes

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4
Q

What are “funny turns”?

A

psychogenic attacks

non-epileptic events

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5
Q

How common is epilepsy?

A

very common!

chance of having an epileptic seizure in your life?? –> 5%

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6
Q

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

A

75%

that leaves 25% uncontrolled and “potential” candidates for epilepsy surgery

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7
Q

What are the statistics of epilepsy in Canada?

A

1.5 million with an epileptic seizure

375,000 with intractable epilepsy

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8
Q

What are epilepsy surgery “work ups” or investigations?

A

history (semiology) and physical exam

neuro-imaging

EEG

other stuff

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9
Q

What is a standard anterior temporal lobectomy?

A

don’t take out whole lobe, only a part of it

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10
Q

How does the hippocampus relate to epilepsy?

A

most seizure prone area of the brain

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11
Q

What are the structures surrounding the hippocampus?

A

superior temporal gyrus

middle temporal gyrus

inferior temporal gyrus

fusiform gyrus

parahippocampal gyrus

hippocampus, amygdala

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12
Q

What is the internal architecture of the hippocampus?

A

CA 1
CA 2
CA 3
CA 4
granule cell layer

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13
Q

What does damage to the CA1 cause?

A

damage causes temporal lobe epilepsy

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14
Q

What will cutting the blood vessels during surgery cause?

A

cutting blood vessels can call stroke

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15
Q

What are types of imaging in a brain with epilepsy?

A

CT Scan (1970’s and 80’s)

MRI (mesial temporal sclerosis, cortical dysplasia)

EEG (right temporal seizure, left temporal seizure)

PET scan (won’t be metabolizing normally)

SISCOM (subtracted ictal SPECT co-registered with MRI)

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16
Q

What are methods of invasive monitoring?

A

depth electrodes (SEEG): little electrodes in the brain without opening up the brain

grid electrodes: big operation

17
Q

What are types of epileptic surgery?

A

temporal lobectomy/resection

selective amygdalohippocampectomy

extra temporal resection

awake craniotomy

vagal nerve stimulation

LiTT (laser interstitial thermo therapy)

multiple subpial resection

18
Q

What is an awake craniotomy?

A

intraoperative stimulation under local anesthesia

bipolar stimulation (Ojemman stimulator) as well as monopolar white matter stimulation

mapping: motor, sensory, langauge

19
Q

What is the biological basis of fMRI?

A

fMRI is dependent on the blood oxygen level dependent (BOLD) signal

differences in magnetic susceptibility can be measured

20
Q

What is the hemodynamic response?

A

signal change (condition-baseline) (0.2-3%)

can tell which part of the brain is responsible for which task

21
Q

What is a language fMRI?

A

characterize areas of the brain that are responsible for speech

22
Q

What is diffusion weighted imaging?

A

tractography

Brownian motion of water molecule

behavior of hydrogen

23
Q

What is diffusion anisotrophy?

A

diffusion is greater in the axis parallel to the orientation of the nerve fibre

24
Q

What is laser interstitial therapy (LiTT)?

A

a new treatment for epilepsy and other stuff

minimally invasive way to insert a catheter into the brain

need three things: energy source, medium, optical cavity

25
Q

What is laser thermal ablation?

A

thermal destruction of tissue by elevation to lethal temperatures

apply heat to target but not the surrounding tissue

26
Q

What are the main points regarding epileptic surgery?

A

epilepsy is common

most people are controlled on medication

surgery is available for some types of epilepsy

most epilepsy surgery is in the temporal lobe

NEURO 210 (23 decks)

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