Michael R Trimble, M. Frederick Andermann Patrick Chauvel Dr. Giuliano Avanzini Dr. Olsen, PhD Michael A. Rogawski, MD, PhD. John M. Willem F. Arts Alexis Arzimanoglou Oebele F. Brouwer Carol Camfield Peter Camfield. Claire M. Lathers Paul L. Schraeder Jan E. Leestma Braxton B. Wannamaker Richard L. Verrier Steven C Schachter, M. Please send me information about ILAE activities and other information of interest to the epilepsy community. Home Education Books on Epilepsy. Print Share.
Books on Epilepsy There has been a steady increase in the number of books published that are relevant to epilepsy that members of the League will likely find useful for their practice or research. Found 75 Books. Atlas of electroencephalography Volume 2 : The Epilepsies. Neubauer Andreas Hahn. Stafstrom Jong M. Epileptic Syndromes in Infancy, Childhood and Adolescence - 6th ed. Handbook of EEG Interpretation, 2nd ed. In the past, skull x-rays, ventriculograms, pneumoencephalography and computerized tomography CT scans demonstrated indirect evidence of cerebral pathology in the form of focal or diffuse atrophy or space-occupying lesions.
Recently, magnetic resonance imaging MRI has replaced CT scanning as the imaging study of choice to evaluate patients with epilepsy. MRI is an extremely sensitive tool that can detect abnormalities of the brain with exceptional anatomical detail. This has been especially true for detecting focal atrophy e. These studies reveal epileptic areas as hypometabolic between seizures and hypermetabolic during seizures.
Ictal SPECT studies can be obtained if injection of an appropriate radioisotope is performed within seconds of a seizure onset. The isotope is concentrated in the region of seizure onset and imaging studies can be obtained up to several hours after injection to demonstrate the area of ictal onset. These studies have been useful in many patients with occult epileptic foci.
Electroencephalographic EEG investigation remains the most important aspect of the presurgical evaluation. Analysis of unselected EEG activity between events interictal or of specific activity during events ictal can provide evidence of focal electrical dysfunction. While certain interictal EEG abnormalities spike and slow wave complexes can be of localizing value, it is considered extremely important to record the EEG with concomitant videotape during the spontaneous occurrence of the patient's events.
Sophisticated computer hardware and software also allows for automatic detection of spontaneous interictal epileptiform transients and electrographic seizures that otherwise might have gone unrecognized. Patients are often hospitalized with reduction in anti-seizure medications and may be recorded for up to days in order to capture of their habitual seizures.
Detailed neuropsychological testing is carried out to reveal specific focal or multifocal cognitive deficits that might be correlated with the neuroimaging and EEG.
This testing may help in localizing an abnormal area of the brain but also serves as a comparison for post-surgical evaluation. An intracarotid amobarbital test is generally done as a prelude to surgery in order to lateralize language and memory function and to avoid neurocognitive deficits. Psychosocial evaluation is also extremely important to assess current level of functioning and to ensure realistic goals and attitudes are engendered in both the patient and their family prior to surgery.
They have the disadvantage, however, of sampling from a relatively small area of cerebrum surrounding the contact points and the fact that they are accompanied by a surgical risk. They should only be undertaken after appropriate noninvasive monitoring has been completed so that an hypothesis of seizure onset has been formulated and a clear goal of the investigation has been defined.
Frontal lobe epilepsy
The diagnostic surgical options of implanted electrodes include epidural, subdural and intracerebral or depth electrodes. Epidural electrodes are used infrequently and generally only for lateralization and approximate localization of seizure onset. Because they do not penetrate the dura the risk of infection is minor. These electrodes can only record from the lateral convexity of the cerebral hemispheres and therefore are limited in their spatial resolution.
These electrodes are placed subdurally on the surface of the brain in the form of rectangular grids or linear strips with flat metal contact points mounted in flexible plastic.
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The grids require a craniotomy for placement and therefore are limited to unilateral application. The strip electrodes can be placed through burr holes over the lateral convexity or under the frontal or temporal lobes. The major advantage of subdural electrodes is that they do not penetrate cerebral tissue and can record from a relatively wide area of the cortical surface. They can also be used for extraoperative cortical stimulation to map out specific areas of cortical function. Unfortunately, subdural electrodes cannot record directly from the deep cerebral structures i.
Intracerebral depth electrodes can be placed stereotactically into deep cerebral structures with the aid of CT, MR and angiography.
Adult Epilepsy Surgical Options
Most centers employ flexible electrodes with multiple contact points that are placed through small holes in the skull and secured with some form of cranial fixation. Electrodes are usually targeted towards the amygdala, hippocampus, orbital-frontal and cingulate regions and may be inserted via a lateral or vertex approach. Using a lateral approach, stereotactic cerebral angiography must be utilized to avoid major blood vessels during placement of the depth electrodes. Depth electrodes may be used in combination with scalp or subdural electrodes for more extensive coverage.
Depth electrode investigation is generally indicated for patients with bitemporal, bifrontal of frontal temporal seizures and can localize a focal area of seizure onset not possible with scalp recordings.
If the information obtained during the noninvasive presurgical evaluation consistently points towards a single area of the brain as being the site of seizure onset, then the patient may be taken directly to surgery for resection of that area. If neuro-imaging demonstrates a well-characterized lesion i.
However, if the data gathered from the clinical examination, imaging studies and noninvasive EEG evaluation are conflicting or disparities arise in the presumed localization of the seizure, then invasive intracranial monitoring is warranted. This is especially true in the extra-temporal epilepsies where EEG localization is notoriously difficult.
If a localized area of seizure onset is confirmed then these patients too can undergo resective surgery. Epilepsy surgery began as removal of gross structural lesions of the brain.
Frontal lobe epilepsy - Wikipedia
With the addition of EEG data from preoperative and intraoperative recordings, areas of removal expanded to include tissue that was grossly normal in appearance but known to give rise to epileptiform activity. Small areas of resection were soon replaced by partial lobectomies and more extensive cortical resection. While resection techniques lesionectomy, lobectomy, hemispherectomy, corticectomy generally yield the best surgical results, disconnection callosotomy, subpial transection and augmentation cerebellar and vagal stimulation techniques remain worthwhile considerations.
The primary objective of most epilepsy surgical procedures is to accurately localize and then completely excise the epileptogenic region without causing cognitive or neurologic deficit. An important determinant of the risk of surgery is the relationship of the lesion to functionally important or "eloquent" brain regions because injury to these "eloquent" areas can cause irreversible neurologic impairment. The location of many functionally important areas can be approximated using anatomic landmarks but individual variations occur and the presence of local pathology can distort landmarks making localization imprecise.
Regions responsible for seizure onset must be distinguished from regions of critical cortical function and a variety of strategies have therefore been employed both pre- and intra-operatively to optimize surgical resection while minimizing risk of injury to functional cortex. Some centers utilize intraoperative cortical recordings to sample EEG activity from the cerebral surface and to allow for cortical mapping. Classical cortical mapping requires a craniotomy under local or light general anaesthesia and direct electrical stimulation of the cortex using a hand-held stimulator.
Centers that use subdural grid electrodes may carry out functional mapping extraoperatively, in advance of the cortical excision, by passing small currents between implanted electrodes. Localization of the rolandic sulcus may also be carried out by recording somatosensory evoked potentials and the recognition of their phase reversal over the sulks.
- Prediction of neuropsychological outcome after resection of temporal and extratemporal seizure foci.
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This powerful neuroimaging technique can create an anatomical and functional model of an individual patient's brain. Rapid echoplanar imaging performed while the patient engages in a specific task i.