Epilepsy surgical

The epilepsies constitute a common, serious neurological disorder in humans, affecting approximately 60 million people worldwide. Well in excess of 40 distinct epileptic syndromes have been identified to date. Current treatment is only symptomatic except in uncommon instances when surgical treatment is possible. While available antiseizure medications target ion channels such as the y-amino-butyric acid (GABA)a receptor and voltage activated sodium (Na+) channels, current research seeks to elucidate the cellular and molecular mechanisms by which a normal brain becomes epileptic. Hopefully, this research will lead to the identification of new targets for which small molecules can be identified and used for prevention or cure of epilepsy. 

It is indicated as hypnotic, in anxiety, tension, muscle spasm, psychosomatic and behaviour disorders, dysmenorrhoea, cerebral palsy, upper motor neuron spasticity, sedative for surgical procedures, labour, tetanus, eclampsia and epilepsy. 

For sedation and amnesia before medical and surgical procedures For treatment of epilepsy and seizure states... 

Traditional treatment of epilepsy involves anticonvulsants to block excitatory transmission. The majority of these antiepileptic drugs are known ion channel blockers [for a summary see Gourfin-kel-An et al. (2004)] More drastic approaches involve surgical removal of the epileptic foci. Gene therapy approaches attempt to block excitation by blocking gene expression (Xiao et al., 1997 Haberman et al., 2002) of excitatory neurotransmitters or by overexpression of the genes involved in inhibition of excitation (Haberman et al., 2003 Lin et al., 2003 Richichi et al., 2004). 

Epilepsy can be caused by genetic factors, brain trauma or injury, viral infections, and likely additional factors that have not yet been discovered. Some people, who may not even be diagnosed with epilepsy, may experience seizures in response to certain patterns of lights and sounds. More severe cases sometimes require the part of the brain that is believed to be the source of the massive storm of electrical signals to be removed surgically. However, epileptic seizures are usually treated with anticonvulsant medications. 

Epilepsy develops in 14-20% of patients, and putative risk factors include subdural hematoma, cerebral infarction, disability on discharge, ventricular drain insertion and surgical treatment (Olafsson et al. 2000 Claassen et al. 2003). 

Devinsky O, Vazquez B, Faught E, Leppik IE, Pellock JM, Schachter S, Alderfer V, Holdich TA. A double-blind, placebo-controUed study of remacemide hydrochloride in patients with refractory epilepsy following pre-surgical assessment. Seizure 2002 ll(6) 371-6. 

Multiple surgical biopsies (0.02-0.1 g) were obtained during resections from brain tumours and from the active site and underlying white matter of patients with intractable epilepsies. Proton MR spectra were obtained on a Bruker AM 8.5 T spectrometer at 37°C. The data set consisted of the H MR spectra of tissue specimens from meningiomas (M-95 24 cases) and astrocytomas (A-74 26 cases), and intractable epilepsy as the control (E-37 8 cases). 

A study to document the outcomes of epilepsy treatment, conducted by Hirsch and Van Den Eeden (1997), illustrates some of the challenges associated with collecting burden of illness data. The traditional clinical measure of seizure frequency is no longer considered appropriate as the sole measure of outcome of treatment or surgical intervention. The additional variables to document the burden of illness that were found illustrate the gap between the type of data desired and what is available. Hitherto, QOL had been assessed in epilepsy patients using no fewer than 12 different... 

Substances that slow or reduce brain activity, notably by a reduction in neuronal activity, ate often referred to as CNS depressants. Central nervous system depressants ate routinely used to treat anxiety, epilepsy and insomnia. They are also important in general anesthesia for major surgical operations. 

We determined the synergistic effect of 0.5 pM EPA on 15 pAf carbamazepine in CAl neurons from healthy rats, in CAl neurons isolated from the hippocampus surgically removed from patients with intractable temporal lobe epilepsy, and in neocortical pyramidal neurons from the same patients (for details on methods, see Vreugdenhil Wadman, 1999). Figure 7B shows a clear relation between the shift in the inactivation curve induced by 15 iM carbamazepine and the additional shift induced on top of 0.5 pM EPA. This suggests that the effect of a therapeutically relevant dose of carbamazepine can be boosted by subthreshold levels of PUFAs. 

Vagal nerve stimnlator (VNS)—A medical device that is surgically implanted in patients with refractory epilepsy. 

Babb TL, Brown WJ. Pathological findings in epilepsy. In Engel J, ed. Surgical Treatment of the Epilepsies. New York Raven Press 1987 511-540. 

Prater JL, Prayson RA, Morris 111 HH, et al. Surgical pathologic findings of extratemporal-based intractable epilepsy A study of 133 consecutive reactions. Arch Pathol Lab Med. 2000 124 545-549. 

Smith DF, Hutton JL, Sandemann D, et al. The prognosis of primary intracerebral tumours presenting with epilepsy The outcome of medical and surgical management. J Neurol Neurosurg Psychiatry. 1991 54 915-920. 

Grigorenko, E.V. et al.. Editing status at the Q/R site of the GlnR2 and GlnR6 glntamate receptor subunits in the surgically excised hippocampus of patients with refractory epilepsy. Neuroreport, 9, 2219, 1998. 

Epilepsy is a medical condition that is very frequent around the world. It is estimated that 1% of the population suffers epilepsy. From these patients, only 70% are controlled with antiepileptic medication. The other 30% of patients may benefit from surgical intervention. The use of chronic stimulation of the brain, so called neiu omodulation, has shown to be a reliable procedure in the control of epileptic seizures. In 1970, the first totally implantable stimulating systems were available [Rise, 2000]. Based on the work of Cooke and Snider [ 1955], Cooper etal. [1978] used cerebellar stimulation to control different varieties of epileptic seizures. 

Williamson, P.D., French, J.A., and Thadani, V.M. Characteristics of medial temporallobe epilepsy II. Inter-ictal and ictal scalp electroencephalography, neuropsychological testing, neuroimaging, surgical results and pathology. Ann. Neurol. 1993,34 781-787. 

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