20% of patients continue to have seizures even with anti epileptic drugs. Many of these patients may be candidate for surgical procedures to control their seizures. Largest group of surgical candidates are with mesial temporal epilepsy which is often medically refractory.
Preoperative evaluation with EEG and functional brain imaging like fMRI, MEG,PET can provide important information for treating medically refractory epilepsy . The candidates for epilepsy surgery are usually patients who are refractory to standard medical treatment and have epilepsy that is disabling. Clinical history, neurological examination, EEG, video EEG , brain MRI with M specroscopy, PET, SPECT, functional MRI, Magnetoencephalography (MEG) and neuropsychological testings help in the decision making.
WADA test or intracarotid amytal test localizes side of language function and dominant hemisphere and is required for resecting a large cortical lesion.
EEG obtained with invasive electrodes or depth electrodes for cortical mapping and is used to identify eloquent areas for planning a safe resection.
Surgical options:
1. Vagal Nerve Stimulation
2. Deep Brain Stimulation ( DBS ) of thalamus ( for GTCS ), or hippocampus ( for partial seizures )
3. Disconnection: Callosotomy ( resection of corpus callosum ) or hemispherectomy of multiple subpial resections.
4. Resection of epileptic focus : Anterior temporal lobectomy, amygdalo- hippocampectomy, neocortical resection or resection of the lesion in secondary epilepsy ( e.g. cavernous malformation )
Preoperative evaluation with EEG and functional brain imaging like fMRI, MEG,PET can provide important information for treating medically refractory epilepsy . The candidates for epilepsy surgery are usually patients who are refractory to standard medical treatment and have epilepsy that is disabling. Clinical history, neurological examination, EEG, video EEG , brain MRI with M specroscopy, PET, SPECT, functional MRI, Magnetoencephalography (MEG) and neuropsychological testings help in the decision making.
WADA test or intracarotid amytal test localizes side of language function and dominant hemisphere and is required for resecting a large cortical lesion.
EEG obtained with invasive electrodes or depth electrodes for cortical mapping and is used to identify eloquent areas for planning a safe resection.
Surgical options:
1. Vagal Nerve Stimulation
2. Deep Brain Stimulation ( DBS ) of thalamus ( for GTCS ), or hippocampus ( for partial seizures )
3. Disconnection: Callosotomy ( resection of corpus callosum ) or hemispherectomy of multiple subpial resections.
4. Resection of epileptic focus : Anterior temporal lobectomy, amygdalo- hippocampectomy, neocortical resection or resection of the lesion in secondary epilepsy ( e.g. cavernous malformation )
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