Seizure surgery: Difference between revisions
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==Overview== | ==Overview== | ||
[[Surgery]] may be helpful in patients with [[focal epilepsy]] if there is no seizure control after two or more [[antiepileptic drugs |antiepileptic drugs (AEDs)]]. [[Laser]] interstitial [[thermal ablation]] and neurostimulation may be helpful as alternative therapies to [[surgery]] in some patients. | [[Surgery]] may be helpful in [[patients]] with [[focal epilepsy]] if there is no seizure control after two or more [[antiepileptic drugs |antiepileptic drugs (AEDs)]]. [[Laser]] interstitial [[thermal ablation]] and neurostimulation may be helpful as alternative therapies to [[surgery]] in some [[patients]]. | ||
==Surgery== | ==Surgery== | ||
===Surgery=== | ===Surgery=== | ||
* [[Surgery]] may be helpful in patients with [[focal epilepsy]] if:<ref name="pmid30704683">{{cite journal| author=Johnson EL| title=Seizures and Epilepsy. | journal=Med Clin North Am | year= 2019 | volume= 103 | issue= 2 | pages= 309-324 | pmid=30704683 | doi=10.1016/j.mcna.2018.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30704683 }} </ref> | * [[Surgery]] may be helpful in [[patients]] with [[focal epilepsy]] if:<ref name="pmid30704683">{{cite journal| author=Johnson EL| title=Seizures and Epilepsy. | journal=Med Clin North Am | year= 2019 | volume= 103 | issue= 2 | pages= 309-324 | pmid=30704683 | doi=10.1016/j.mcna.2018.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30704683 }} </ref> | ||
** The [[brain]] region that is the seizure origin can be safely removed. | ** The [[brain]] region that is the seizure origin can be safely removed. | ||
** There is no seizure control after two or more [[antiepileptic drugs |antiepileptic drugs (AEDs)]]. | ** There is no seizure control after two or more [[antiepileptic drugs |antiepileptic drugs (AEDs)]]. | ||
*** Two randomized controlled trials showed that the rate of seizure freedom in patients with [[temporal lobe epilepsy]] that had surgery was 60% to 85%, compared with 0% to 8% to those that had continued medical treatment.<ref name="pmid22396514">{{cite journal| author=Engel J, McDermott MP, Wiebe S, Langfitt JT, Stern JM, Dewar S | display-authors=etal| title=Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. | journal=JAMA | year= 2012 | volume= 307 | issue= 9 | pages= 922-30 | pmid=22396514 | doi=10.1001/jama.2012.220 | pmc=4821633 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22396514 }} </ref><ref name="pmid11484687">{{cite journal| author=Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group| title=A randomized, controlled trial of surgery for temporal-lobe epilepsy. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 5 | pages= 311-8 | pmid=11484687 | doi=10.1056/NEJM200108023450501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11484687 }} </ref> | *** Two [[randomized controlled trials]] showed that the rate of seizure freedom in [[patients]] with [[temporal lobe epilepsy]] that had [[surgery]] was 60% to 85%, compared with 0% to 8% to those that had continued [[medical]] [[treatment]].<ref name="pmid22396514">{{cite journal| author=Engel J, McDermott MP, Wiebe S, Langfitt JT, Stern JM, Dewar S | display-authors=etal| title=Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. | journal=JAMA | year= 2012 | volume= 307 | issue= 9 | pages= 922-30 | pmid=22396514 | doi=10.1001/jama.2012.220 | pmc=4821633 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22396514 }} </ref><ref name="pmid11484687">{{cite journal| author=Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group| title=A randomized, controlled trial of surgery for temporal-lobe epilepsy. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 5 | pages= 311-8 | pmid=11484687 | doi=10.1056/NEJM200108023450501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11484687 }} </ref> | ||
=== Laser Interstitial Thermal Ablation=== | === Laser Interstitial Thermal Ablation=== | ||
[[Laser]] interstitial [[thermal ablation]] may be helpful as an alternative therapy to [[surgery]] in patients with some types of [[focal epilepsy]].<ref name="pmid30704683">{{cite journal| author=Johnson EL| title=Seizures and Epilepsy. | journal=Med Clin North Am | year= 2019 | volume= 103 | issue= 2 | pages= 309-324 | pmid=30704683 | doi=10.1016/j.mcna.2018.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30704683 }} </ref> | [[Laser]] interstitial [[thermal ablation]] may be helpful as an alternative therapy to [[surgery]] in [[patients]] with some types of [[focal epilepsy]].<ref name="pmid30704683">{{cite journal| author=Johnson EL| title=Seizures and Epilepsy. | journal=Med Clin North Am | year= 2019 | volume= 103 | issue= 2 | pages= 309-324 | pmid=30704683 | doi=10.1016/j.mcna.2018.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30704683 }} </ref> | ||
* With [[MRI]] guidance a thermal [[probe]] targeting the seizure origin is placed and then heat is ablates the [[tissue]].<ref name="pmid24618797">{{cite journal| author=Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C | display-authors=etal| title=Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. | journal=Neurosurgery | year= 2014 | volume= 74 | issue= 6 | pages= 569-84; discussion 584-5 | pmid=24618797 | doi=10.1227/NEU.0000000000000343 | pmc=4151501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24618797 }} </ref> | * With [[MRI]] guidance a thermal [[probe]] targeting the seizure origin is placed and then heat is ablates the [[tissue]].<ref name="pmid24618797">{{cite journal| author=Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C | display-authors=etal| title=Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. | journal=Neurosurgery | year= 2014 | volume= 74 | issue= 6 | pages= 569-84; discussion 584-5 | pmid=24618797 | doi=10.1227/NEU.0000000000000343 | pmc=4151501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24618797 }} </ref> | ||
===Neurostimulation=== | ===Neurostimulation=== | ||
[[Patients]] that are not candidates for [[surgery]] may be treated with neurostimulation:<ref name="pmid30704683">{{cite journal| author=Johnson EL| title=Seizures and Epilepsy. | journal=Med Clin North Am | year= 2019 | volume= 103 | issue= 2 | pages= 309-324 | pmid=30704683 | doi=10.1016/j.mcna.2018.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30704683 }} </ref> | |||
* [[Vagus nerve]] stimulation: | * [[Vagus nerve]] stimulation: | ||
** [[Surgical]] placement of a [[subcutaneous]] stimulator in the [[chest]] and a stimulating wire in the [[neck]] (the [[vagus nerve]]). | ** [[Surgical]] placement of a [[subcutaneous]] stimulator in the [[chest]] and a stimulating wire in the [[neck]] (the [[vagus nerve]]). | ||
* Responsive neurostimulation device: | * Responsive neurostimulation device: | ||
** Directly detects seizures with implanted intracranial [[electrodes]]<ref name="pmid24752127">{{cite journal| author=Ben-Menachem E, Krauss GL| title=Epilepsy: responsive neurostimulation-modulating the epileptic brain. | journal=Nat Rev Neurol | year= 2014 | volume= 10 | issue= 5 | pages= 247-8 | pmid=24752127 | doi=10.1038/nrneurol.2014.69 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24752127 }} </ref> | ** Directly detects seizures with implanted intracranial [[electrodes]].<ref name="pmid24752127">{{cite journal| author=Ben-Menachem E, Krauss GL| title=Epilepsy: responsive neurostimulation-modulating the epileptic brain. | journal=Nat Rev Neurol | year= 2014 | volume= 10 | issue= 5 | pages= 247-8 | pmid=24752127 | doi=10.1038/nrneurol.2014.69 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24752127 }} </ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Epilepsy]] | [[Category:Epilepsy]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 15:06, 21 April 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Overview
Surgery may be helpful in patients with focal epilepsy if there is no seizure control after two or more antiepileptic drugs (AEDs). Laser interstitial thermal ablation and neurostimulation may be helpful as alternative therapies to surgery in some patients.
Surgery
Surgery
- Surgery may be helpful in patients with focal epilepsy if:[1]
- The brain region that is the seizure origin can be safely removed.
- There is no seizure control after two or more antiepileptic drugs (AEDs).
- Two randomized controlled trials showed that the rate of seizure freedom in patients with temporal lobe epilepsy that had surgery was 60% to 85%, compared with 0% to 8% to those that had continued medical treatment.[2][3]
Laser Interstitial Thermal Ablation
Laser interstitial thermal ablation may be helpful as an alternative therapy to surgery in patients with some types of focal epilepsy.[1]
- With MRI guidance a thermal probe targeting the seizure origin is placed and then heat is ablates the tissue.[4]
Neurostimulation
Patients that are not candidates for surgery may be treated with neurostimulation:[1]
- Vagus nerve stimulation:
- Surgical placement of a subcutaneous stimulator in the chest and a stimulating wire in the neck (the vagus nerve).
- Responsive neurostimulation device:
- Directly detects seizures with implanted intracranial electrodes.[5]
References
- ↑ 1.0 1.1 1.2 Johnson EL (2019). "Seizures and Epilepsy". Med Clin North Am. 103 (2): 309–324. doi:10.1016/j.mcna.2018.10.002. PMID 30704683.
- ↑ Engel J, McDermott MP, Wiebe S, Langfitt JT, Stern JM, Dewar S; et al. (2012). "Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial". JAMA. 307 (9): 922–30. doi:10.1001/jama.2012.220. PMC 4821633. PMID 22396514.
- ↑ Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group (2001). "A randomized, controlled trial of surgery for temporal-lobe epilepsy". N Engl J Med. 345 (5): 311–8. doi:10.1056/NEJM200108023450501. PMID 11484687.
- ↑ Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C; et al. (2014). "Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy". Neurosurgery. 74 (6): 569–84, discussion 584-5. doi:10.1227/NEU.0000000000000343. PMC 4151501. PMID 24618797.
- ↑ Ben-Menachem E, Krauss GL (2014). "Epilepsy: responsive neurostimulation-modulating the epileptic brain". Nat Rev Neurol. 10 (5): 247–8. doi:10.1038/nrneurol.2014.69. PMID 24752127.