Epilepsy: Insights into Consciousness

Obligatory Historical Quote: “Men ought to know that from the brain… madness comes from its moistness. When the brain is abnormally moist, of necessity it moves, and when it moves neither sight nor hearing are still… But when the brain is still, a man can think properly. - Hippocrates, ~ 5 th Century B.C.

Circuitry of the Brain ~100 billion neurons with ~ 200 trillion contacts between them

Pathology of Circuits

Seizures Vs. Epilepsy A seizure is a symptom (like a fever)

Definitions: Seizure: – A time-limited and involuntary alteration in behavior, accompanied by an abnormal electrical discharge in the brain. Uncontrolled, excessive, and hyper-synchronous discharge of cortical neurons Epilepsy: – The tendency to have recurrent, non provoked seizures. Classify seizures into different types of disease

Types of Seizures Classify by the brain areas involved (and EEG): – Partial Seizure: Arise from a delimited brain region No impairment of awareness = Simple Impairment of awareness = Complex – Generalized Seizure Involves the whole brain Only impaired awareness = Absence Includes motor involvement = Tonic-Clonic/Grand Mal

Videos:

Localizing Seizures: Aura: – Visual: See spots, stars, blobs, etc Occipital cortex – Auditory: Hear music, voices, ringing, etc Superior temporal cortex – Olfactory: Smell burning, etc Uncinate cortex – Fear: Amygdala – Sexual: Erotic feelings, inappropriate arousal Medial Temporal lobe

Treatment Acute Management Long-Term Management (Drugs) Surgical Management

Medical Management: Drugs 60-70% of patients can be successfully treated – Can consider weaning medication if seizure free (except in certain cases) Most drugs affect ion-channels or neurotransmitters: – Sodium, Calcium, Chloride, GABA Most common cause of treatment failure is noncompliance

When All Else Fails: Surgery Selection Criteria: – Refractory to medical therapy ( failed 3 or more drugs with different mechanisms of action) – Imaging suggests progressive disorder

Surgical Options It’s scary, but: – Consider the alternatives: Living in constant risk: Driving, Heights, Water, Fire/Burns, Tools, etc. – In Texas must be 6 months seizure free to drive

Localizing Seizures: Electrocorticography (ECoG)

Research Opportunities: Unparalleled opportunity to study brain function Making surgery safer for future patients What NOT to cut!

Functional Brain Mapping

Multi-Modal Analysis

…And Cool Videos

Brain Computer Interface (BCI) “Woman with Quadriplegia Feeds Herself Chocolate Using Mind-Controlled Robot Arm” –

Questions?

Treatments: