W5_05 Epilepsy Surgery

Question 1

focal seizures from which part of the brain have a better chance of a surgical cure?

Answer 1

temporal

Question 2

what proportion of people get surgery for epilepsy each year?

Answer 2

about 2%

Question 3

how long does it take to get surgery for epilepsy, from the time of the first seizure?

Answer 3

22 years

Question 4

the hippocampus takes afferents from what?

Answer 4

cerebral cortex;
septal area;
contralateral hippo.;
nuclei in reticular formation;
subcortical afferents

Question 5

amygdala gets afferents from what?

Answer 5

olfactory;

hypothalamus

Question 6

amygdala sends efferents to what?

Answer 6

dorsal nucleus of vagus;

nucleus solitarius

Question 7

name some auras of temporal lobe epilepsy

Answer 7

deja vu (affecting hippo);
nasty smell (affecting uncus/amygdala);
fear and anxiety (affecting amygdala);
autonomic nuclei

Question 8

what happens in seizures of TLE?

Answer 8

blank stare;
automatic behaviour;
orofacial twitching;
speech arrest;
wandering;

Question 9

what happens in post-ictal phase of TLE seizures?

Answer 9

disoriented;
tired;
headache;
psychotic;
depressed LoC if progression to generalized seizure

Question 10

what is the most frequent lesion associated with medical refractory TLE?

Answer 10

mesial temporal sclerosis;

Question 11

loss of neurons in CA1, CA4, and dentate gyrus is a characteristic of what?

Answer 11

mesial temporal sclerosis

Question 12

the dominant side of temporal lobe is responsible for what?

Answer 12

verbal memory

Question 13

the non-dominant side of temporal lobe is responsible for what?

Answer 13

visual/spatial memory

Question 14

what is the wada test used for?

Answer 14

determine dominance via language hemisphere selection (intracarotid amytal test)

Question 15

what is the eSAM test for?

Answer 15

etomidate speech and memory test

Question 16

risk to memory is highest when surgery is done on which side?

Answer 16

it’s especially risky on the side that’s dominant for speech

Question 17

risks of surgery?

Answer 17

risk to language;
visual field cuts;
stroke;
infection;
hemorrhage

Question 18

what’s the success rate of surgery for TLE patients?

Answer 18

over 80% are seizure free