Epilepsy surgery.

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Presentation transcript:

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