Epilepsy

Question 1

who are candidates for epilepsy surgery

Answer 1

Resective surgery for partial seizures, with a single focus.
Must be possible to define the focus accurately
medically intractable
risks<benefits
Other epilepsies may also respond to VNS

Question 2

what is intractable focal epilepsy?

Answer 2

Stereotyped focal onset - principally diagnosed by history.

Question 3

what are the different epilepsy resection operations?

Answer 3

focal
major
disconnection
functional

Question 4

focal resections

Answer 4

temporal lobectomy
lesionectomy
etc

Question 5

major resection

Answer 5

multilobar
hemispherectomy
hemispherotomy

Question 6

disconnection

Answer 6

multiple subpial transection
callostomy

Question 7

functional tx

Answer 7

vagus nerve stimulation
deep brain stimulation

Question 8

what is hemispherectomy?

Answer 8

Intractable partial epilepsy arising in one damaged hemisphere

Question 9

what % of pt are seizure free after a hemispherectomy?

Answer 9

90%

Question 10

features of syndrome of mesial temporal lobe

Answer 10

febrile convulsions
onset around 12 years old
aura
initial arrest
ipsilateral automatisms
contralateral dystonic posturing
post ictal dysphasia
post ictal psychosis
generalisation (rare)

Question 11

what is the surgery for mesial temporal lobe syndrome

Answer 11

en bloc anterior temporal lobectomy

Question 12

what is the amytal/ wada test?

Answer 12

is a procedure used in presurgical planning, particularly for epilepsy surgery.
It helps determine which hemisphere of the brain is dominant for language and memory functions.

Question 13

Why might someone with severe epilepsy suffer from psychiatric disturbance?

Answer 13

Acute changes in brain chemistry
Social isolation
Educational difficulties
Stigma

Question 14

underlying causes of psychiatric disturbances in epilepsy

Answer 14

Structurally abnormal brain
Functionally abnormal brain
Psychiatric disease is common

Question 15

how can surgery affect psychiatric state

Answer 15

structural changes to the frontal lobes and hippocampal volume
surgery is a significant life event
anxiety of not having seizures
forced normalisation
burden of normality

Question 15

how can we avoid awake surgery?

Answer 15

intracranial mapping via implanted grid electrodes

Question 16

what is a hypothalamic hamartoma?

Answer 16

a rare, benign (non-cancerous) growth or malformation in the hypothalamus, a part of the brain that regulates many bodily functions.

Question 17

thermocoagulation

Answer 17

a minimally invasive surgical technique used in epilepsy surgery to create thermal lesions in the brain, disrupting the epileptic network
often considered for patients with refractory focal epilepsy especially when surgical resection is not feasible or when the target is in a high-risk area.

Question 18

stereotactic radiosurgery (gamma knife radiosurgery)

Answer 18

a minimally invasive procedure that uses focused beams of radiation to target the area of the brain where seizures originate

Question 19

disadvantages of gamma knife radiosurgery

Answer 19

• delayed seizure cessation/
  transient worsening
• delayed psycho-social benefit
• small therapeutic window
• SUDEP risk
• lack of data

Question 20

advantages of gamma knife radiosurgery

Answer 20

• no disruption of psychosocial life
• cost benefit /
  reduced hospitalisation
• promising neuropsychological
  data

Question 21

DBS in epilepsy

Answer 21

approved by NICE
multiple targets
centromedian nucleus stimulation in generalised epilepsy
targets otherwise difficult to resect

Question 22

responsive neurostimulation

Answer 22

closed loop
detects electrocorticography evidence of a seizure
delivers a pulse to abort the seizure

Question 23

establishing intractability

Answer 23

55% define as failure of monotherapy with two separate drug
92% define as failure of monotherapy with three separate drugs

Question 23

most important factors to consider referral to surgery (according to neurologists)

Answer 23

patient desire seizure frequency duration of epilepsy imaging abnormalities

Question 24

what is the mean time from dx to referral

Answer 24

20 years