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
Rachel Soon, 06 Feb 2017

Similarities in insulin signaling mechanisms between the brains of Alzheimer’s disease patients and the pancreas of diabetic patients may point the way to improved treatment for the former, according to researchers.

08 Sep 2019
High-resistant starch, low-protein flour improves blood glucose and lipid levels among people with early type 2 diabetic neuropathy, as well as improves their ability to prevent antioxidative stress, reports a recent study.