Epilepsy surgery in adults

Lamoureux, Danielle; Spencer, Susan S.

doi:10.1097/00019052-199504000-00003

Cited by 7 publications

(4 citation statements)

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“…For example, although both absence and tonic-clonic seizures exhibit focal features Meeren et al, 2002;Nersesyan et al, 2003), both seizure types studied in this investigation are usually classified as "generalized" (ILAE, 1981). Because epilepsy surgery is usually reserved for localization related epilepsy (Lamoureux and Spencer, 1995;Spencer, 1998), it will be essential to extend these studies to models of localization related epilepsy as well. Another limitation already mentioned is the relatively limited spatial sampling of this method compared to functional neuroimaging.…”

Section: Figmentioning

confidence: 99%

Relative Changes in Cerebral Blood Flow and Neuronal Activity in Local Microdomains during Generalized Seizures

Nersesyan

Hermán

Erdogan³

et al. 2004

J Cereb Blood Flow Metab

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Summary:There is broad agreement that generalized tonicclonic seizures (GTCS) and normal somatosensory stimulation are associated with increases in regional CBF. However, the data regarding CBF changes during absence seizures are controversial. Electrophysiologic studies in WAG/Rij rats, an established animal model of absence seizures, have shown spikewave discharges (SWD) that are largest in the perioral somatosensory cortex while sparing the visual cortex. Recent functional magnetic resonance imaging (fMRI) studies in the same model have also shown localized increases in fMRI signals in the perioral somatosensory cortex during SWD. Because fMRI signals are only indirectly related to neuronal activity, the authors directly measured CBF and neuronal activity from specific microdomains of the WAG/Rij cortex using a specially designed probe combining laser-Doppler flowmetry and extracellular microelectrode recordings under fentanyl/haloperidol anesthesia. Using this approach, parallel increases in neuronal activity and CBF were observed during SWD in the whisker somatosensory (barrel) cortex, whereas the visual cortex showed no significant changes. For comparison, these measurements were repeated during somatosensory (whisker) stimulation, and bicuculline-induced GTCS in the same animals. Interestingly, whisker stimulation increased neuronal activity and CBF in the barrel cortex more than during SWD. During GTCS, much larger increases that included both the somatosensory and visual cortex were observed. Thus, SWD in this model produce parallel localized increases in neuronal activity and CBF with similar distribution to somatosensory stimulation, whereas GTCS produce larger and more widespread changes. The normal response to somatosensory stimulation appears to be poised between two abnormal responses produced by two physiologically different types of seizures.

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Section: Figmentioning

confidence: 99%

Relative Changes in Cerebral Blood Flow and Neuronal Activity in Local Microdomains during Generalized Seizures

Nersesyan

Hermán

Erdogan³

et al. 2004

J Cereb Blood Flow Metab

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“…Although of substantial diagnostic benefit in the selection of patients with medically intractable epilepsy for focal resection, pre-surgical evaluation that includes analysis of 24 hour-video-EEG telemetry (ictal and interictal EEG), multi-modality imaging, neuropsychological evaluation and WADA testing is very expensive. Several investigators have addre-ssed the need for a cost/benefit analysis of the comprehensive evaluation [1][2][3] . To date, there have been two evaluations of the cost-effectiveness of anterior temporal lobectomy in the US 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Assessment and cost comparison of sleep-deprived EEG, MRI and PET in the prediction of surgical treatment for epilepsy

DellaBadia

Bell

Keyes

et al. 2002

Seizure

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Our aim was to determine if less expensive interictal indices can predict which epilepsy patients may benefit from the more expensive comprehensive pre-surgical evaluation. Surgical treatment was determined based on the results of a comprehensive inpatient continuous video-EEG monitoring. This evaluation included three interictal tests, which were reviewed retrospectively-2 hour-sleep-deprived electroencephalogram (SDEEG), magnetic resonance imaging (MRI), and positron emission tomography (PET). Sixty-nine patients were evaluated with 35 patients having focal resection (33 temporal, two frontal). When two or more interictal tests were positive, 77% (27 /35) went to surgery, but when one test was positive 23% (8 /34) had surgery. When all tests were negative, only a single patient (1 /13 or 7.7%) had surgery, a frontal resection. The positive predictive value for any single interictal test was 68%, while it was higher for any combination of two positive tests (77-83%). PET was the most sensitive (0.86) single interictal test, compared to SDEEG (0.66) and MRI (0.66). The odds ratio for predicting surgical treatment for a positive PET, SDEEG, or MRI was 8.57, 4.01, and 4.01, respectively. MRI was three and PET was six times the cost of a SDEEG. The combination of SDEEG and MRI had the best cost/PPV ratio. Seventy-nine percent (11 /14) of the patients with three positive tests were seizure free following focal resection compared to 43% (9 /21) when less than three tests were positive ( P

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“…This section discusses the decision process of epilepsy surgery. The subject of various operative techniques and presurgical evaluations are dealt with in greater depth elsewhere [16][17][18][19]. However, Table 3 has been provided to serve as an overview of the most commonly performed surgeries for epilepsy and their indications.…”

Section: Epilepsy Surgerymentioning

confidence: 99%

The current treatment of epilepsy: A challenge of choices

Sirven

2003

Curr Neurol Neurosci Rep

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There are now several distinct choices for seizure and epilepsy treatment. These include 16 antiepileptic medications, surgery, vagus nerve stimulation, and ketogenic diet. However, not every option is appropriate for all individuals with epilepsy. This article reviews the commonly employed treatments for chronic seizures, with the goal of trying to assess when certain treatments should be considered. An approach to seizure management is presented to help navigate the challenge of epilepsy treatment choices.

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Epilepsy surgery in adults

Cited by 7 publications

References 0 publications

Relative Changes in Cerebral Blood Flow and Neuronal Activity in Local Microdomains during Generalized Seizures

Relative Changes in Cerebral Blood Flow and Neuronal Activity in Local Microdomains during Generalized Seizures

Assessment and cost comparison of sleep-deprived EEG, MRI and PET in the prediction of surgical treatment for epilepsy

The current treatment of epilepsy: A challenge of choices

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