Multimodal Imaging and EEG for Epilepsy

Question 1

EpiNav

Answer 1

Image-guided epilepsy surgery using computer-assisted planning and robotic placement of electrodes

Creates 4D visualisation of seizure onset and spread (space and time) to allows 3D image-guided resections

Improves precision, speed and safety of surgery

Question 2

Symptoms of Focal Epilepsy

Answer 2

Focal epilepsy can originate anywhere in the brain - different parts of the brain are associated with different symptoms

PMC - hand jerking, occipital lobe - visual, temporal lobe - fear/deja vu

Question 3

sEEG Strategy

Answer 3

Compares symptoms with brain recordings from epilepsy to associate symptoms with specific areas of the brain

The computer-assisted electrode trajectory planning can implant intracranial electrodes to the relevant area -> optimises GM sampling, improves safety and efficiency, avoids blood vessels

Can generate a profile of implantations which yield good results

Question 4

sEEG Display and Analysis

Answer 4

After implantation, the brain can be scanned to check electrode placements

Electrode positions can then be linked to an EEG display and a recording taken of seizures to find out where they start in order to plan resection

Can use fMRI to find out areas used in particular skills to avoid these regions being removed

Question 5

Considerations in Epilepsy Surgery

Answer 5

Want to remove the epileptic focus without damaging other important structures, such as those involved in language, memory, sight, blood vessels

Risk is individualised to each patient

Make a detailed 3D model and plan what needs to be resected and what needs to be spared -> appearing to improve seizure outcomes by 70-90% whilst reducing deficits

Question 6

Laser Ablation

Answer 6

Laser used to burn area of epileptic focus

Causes less damage as creates a smaller hole

However, can only be done in a straight line