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Flashcards in Epilepsy surgery Deck (22):
1

Where do complex partial seizure originate?

Temporal lobe

2

Which seizure is surgical? focal vs. general

Focal

3

In focal seizures, which has a higher change of surgical cure?

Temporal focal seizures, vs. any other lobe

4

How do generalized and complex partial seizures compare in terms of response to drug therapy?

Generalized: 50% 12 months remission
CPS: 22-32% 12 months remission

5

What is the likelihood of a patient failing first line of drug treatment to fail additional ones?

an individual with CPS with a lesion on an MRI who fails a first line anti-seizure medications will likely fail every other ASM that is tried

6

How long should normal treatment be tried before surgical treatment should be considered?

1-2 years.

7

What percentage of those eligible for surgery in Ontario actually receive the surgery?

2%

8

What's the chance of a surgical cure for temporal lobe epilepsy?

80-90% chance

9

What are the hippocampal afferents?

Cortex
contalateral hippocampus
Septal area
Nuclei in reticular formation
Largest recipient of entorhinal area
Suncortical afferents

10

What are the efferents for the hippocampus?

Fornix

11

What carries the information to the contralateral hippocampus?

Dorsal hippocampal commisure

12

What carries the information to the septal area?

Pre-commisural fornix

13

What carries the information to the mammillary bodies?

Post-commisural fornix

14

What are the afferents to the amygdala?

From olfactory (forms part of the lateral olfactory area)
from hypothalamus

15

What forms the efferent bundle of the amygdala? where does it project to?

Stria terminalis forms the efferent bundle; it projects to:
1- dorsal nucleus of the vagus nerve
2- solitary nucleus

16

What are the Predrome (aura) of a temporal lobe seizure?

De ja vu: hippocampus
Nasty smell: uncus, corticomedial part of the amygdala
Fear and anxiety: central and basolateral nuclei of the amgydala
autonomic manifestation:
Stria-terminals-> septal area-> stria-medullaris thalami (part of epithalamus)--> habenular nuclei (part of epithalamus)--> fasciculus retrofelxus --> interpeduncular nucleus -->autonomic nuclei

17

What are the symptoms of a temporal lobe seizure?

blank stare
automaticity of behaviour (picking, fumbling, repeating words)
Orofacial automatisms
Speech arrest (esp. if dominant lobe)
Wandering

18

What are the post ictal symptoms of a temporal lobe seizure?

Disoriented
Tired
Psychotic
headache
depressed level of consciousness

19

What is the most common lesion associated with medically refractory TLE?

Mesial temporal sclerosis. 47-70%

20

Describe mesial temporal sclerosis changes

Atrophy of hippocampal formation
loss of neurons and gliosis in dentate gyrus and CA1, CA4.

21

What are the main functions of the temporal lobe in the dominant vs. nondominant hemispheres?

Dominant: Verbal memory, language
Nondominant: visual-spatial memory

22

What are the risks associated with TLE surgery?

Memory, and language esp if dominant side--> improves within a year
Visual field loss
Stroke--> weakness+ visual field loss
Infection
hemorrhage