W5_05 Epilepsy Surgery Flashcards
focal seizures from which part of the brain have a better chance of a surgical cure?
temporal
what proportion of people get surgery for epilepsy each year?
about 2%
how long does it take to get surgery for epilepsy, from the time of the first seizure?
22 years
the hippocampus takes afferents from what?
cerebral cortex; septal area; contralateral hippo.; nuclei in reticular formation; subcortical afferents
amygdala gets afferents from what?
olfactory;
hypothalamus
amygdala sends efferents to what?
dorsal nucleus of vagus;
nucleus solitarius
name some auras of temporal lobe epilepsy
deja vu (affecting hippo); nasty smell (affecting uncus/amygdala); fear and anxiety (affecting amygdala); autonomic nuclei
what happens in seizures of TLE?
blank stare; automatic behaviour; orofacial twitching; speech arrest; wandering;
what happens in post-ictal phase of TLE seizures?
disoriented; tired; headache; psychotic; depressed LoC if progression to generalized seizure
what is the most frequent lesion associated with medical refractory TLE?
mesial temporal sclerosis;
loss of neurons in CA1, CA4, and dentate gyrus is a characteristic of what?
mesial temporal sclerosis
the dominant side of temporal lobe is responsible for what?
verbal memory
the non-dominant side of temporal lobe is responsible for what?
visual/spatial memory
what is the wada test used for?
determine dominance via language hemisphere selection (intracarotid amytal test)
what is the eSAM test for?
etomidate speech and memory test
risk to memory is highest when surgery is done on which side?
it’s especially risky on the side that’s dominant for speech
risks of surgery?
risk to language; visual field cuts; stroke; infection; hemorrhage
what’s the success rate of surgery for TLE patients?
over 80% are seizure free
