Seizures and surgery Flashcards
Which types of seizures are generally well controlled?
Generalize, whereas CPS are NOT well controlled (less remission)
If an individual with CPS fails first line therapy
WILL likely fail every other therapy
- can have surgical cure
First line AEDs
- Carbamazepine
- Lamotrigine
- Oxcarbazepine
- valproic acid
Second line AEDs
- Dilantin
- Topiramate
- Keppra
- Gabapentin
- Phenobarb (why so low on the list)
Which is the most common surgically remediable form of epilepsy?
Temporal lobe epilepsy - 80-90% cure rate
Some of the major afferents of the hippocampus?
nuclei in reticular formation -
olfaction
subcortical afferent
whereas main efferent is fornix system
What are some of the clinical manifestations of TLE?
- Prodrome - aura phase, Deja vu, Smell, Fear/anxiety, rising feeling in abdomen
- blank stare, orofacial automatisms, speech arrest
- post-seizure disorientation, psychotic, headache,
What is the pathology of TLE?
Sclerotic Hippocampus -
Classic description of medial temporal sclerosis?
- Atrophy of Hipp formation
2. Loss of neurons and gliosis
What is the most common medically refractory epilepsy?
Complex partial seizures
Temporal lobe
Mesial temporal sclerosis
2 most important things in pre-surgical assessment?
- Neuropsych
2. Neurosurg
What are the functions of the TL?
- Visual-spatial memory (non-dominant) (right sided)
- Verbal memory (dominant)
- Language (dominant)
What are some of the surgical complications?
- Not seizure free
- Risk to memory (if dominant side for speech)
- risk to language as well -
can have a field Cut - superior homonymous quadrantonopsia, - stroke - or complete field cut….
What % of patients seizure free
80%
