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