epilepsy
EPILEPSY
Epilepsy is a clinical multiaxial diagnosis.
Epileptic seizure is a transient occurrence of signs/symptoms brought about by abnormal excessive or synchronous neuronal activity in the brain.
It is recommended that all patients having a first seizure be referred as soon as possible to a specialist to ensure accurate and early diagnosis and initiation of treatment appropriate to the needs of the patients.

Surgical Intervention

Surgery

  • May be an option for epileptic patients with seizures uncontrolled by pharmacological therapy and those with surgically remediable epileptic syndrome
  • Assess patient for the suitability of curative resective procedures before considering palliative procedures

Curative Resective Procedures

  • Aim to eliminate seizures completely that would potentially lead to permanent remission without the need of antiepileptic drugs
  • Temporal lobe resection
    • The lateral temporal  cortex is resected first then the amygdala and hippocampus are resected
    • Approximately 70-90% of the patients become seizure-free
  • Lesionectomy/focal resection
    •  Resection of epileptogenic focus based on semiology, EEG finding, neuropsychological tests, magnetic resonance imaging (MRI) and positron emission tomography scan
    •  Approximately 50% of the patients become seizure-free
  • Extratemporal resection (frontal, parietal and occipital lobectomy)
    • Resection of respective section of the brain where epileptogenic focus was identified on electrophysiological tests or functional imaging, with no obvious lesion on MRI
    • Approximately 50% of the patients become seizure-free

Palliative Procedures

  • Aim to disconnect the epileptogenic area from other parts of the brain to reduce the severity of seizure
  • Multiple subpial transections for epileptogenic focus at eloquent functional area
  • Anatomical or functional hemispherectomy and hemispherotomy are typically reserved for children with very large areas of seziure onset (eg Rasmussen’s syndrome or cerebral mega-gyrus malformation)
  • Corpus callosotomy - for uncontrolled frequent drop attacks
Laser Interstitial Thermal Therapy
  • Focal ablation of epileptogenic focus using image-guided focal laser thermal energy
Stereotactic Radiosurgery
  • Focal ablation of epileptogenic focus using image-guided focal high-dose radiation

Neurostimulation Device Implantations

  • Reduce frequency of seizures in patients refractory to pharmacological therapy and who are not suitable for resection or palliative surgical procedures
  • Vagus nerve stimulation (VNS)
    • Modulation of cerebral neurotransmitter via stimulation of left vagal nerve in the neck
    • Around 50% of the patients got >50% reduction in seizure frequency
  • Responsive neurostimulation (RNS)
    • A device that can record seizure activity directly from the brain & delivers stimulation to stop seizures
  • Deep brain stimulation (DBS)
    • A surgery that involves implanting an electrode into a specific deep part of the brain amd placing a stimulating device under the skin in the chest
    • The cyclical stimulation reduces the frequency of the seizure
Editor's Recommendations
Most Read Articles
Pearl Toh, 6 days ago
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
Pearl Toh, 2 days ago
After treatment with fremanezumab, a difficult-to-treat patient population with treatment-resistant episodic or chronic migraine saw sustained benefits across a broad range of measures, according to multiple analyses of the FOCUS study released during the AHS 2020 Virtual Meeting.
Roshini Claire Anthony, 13 Aug 2019

An active lifestyle, regardless of vascular risk, may delay the progression of Alzheimer’s disease (AD) by slowing down cognitive decline and neurodegeneration, according to a study presented at the Alzheimer’s Association International Conference (AAIC 2019).

Pearl Toh, 26 Jul 2019
Sex-specific differences in the way brain regions are connected may influence how tau propagates through the brain and thus, differences in the risk of Alzheimer’s disease between men and women; while participating in the workforce may help stave cognitive decline in women, suggest studies presented at AAIC 2019.