Epilepsy surgery

History

Definition

• Seizure

• Convulsion

• Epilepsy

Epidemiology

• Prevalence : 52,000,000 around the world

• 700,000 in Iran

Pathophysiology

• Developmental pathology of brain

• Neuronal and glial disorders

• Kindling phenomenon

• Reorganization of cortical tissue in response to hypoxia

Kindling phenomenon

Treatment

• Standard : monotherapy by antiepileptic drugs

• Traditional : phenobarbital , phenytoin , primidone , carbamazepine , valproic acid

• New : lamotrigine , topiramate , levatiracetam ,…

Failure of medical therapy

• Misdiagnosis • Irregular follow up• Irregularity in treatment• Life style factors• Brain tumors• Sever traumatic brain injury

Refractory epilepsy

•30 % of patients

Causes of refractory epilepsy

• Temporal lob epilepsy : the most common• Neuronal structural disorders • Inflammatory disorders• Autoimmune mechanisms • Tumors and sever traumatic brain injuries

Temporal lobectomy and lesionectomy

Callosotomy

Indications

• Tuberos sclerosis

• Infantile spasm

• Lenox – Gustaut syndrome

Hemispher - ectomy , tomy

Rasmussen's encephalitis

Multiple subpial transection

Vagal nerve stimulation

Mechanism

• Nor epinephrine

• GABA

• Reticular activating system