1. Epilepsy: Insights into Consciousness

2. Obligatory Historical Quote: “Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, griefs and tears... 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, and the tongue speaks in accordance with the things seen and heard on any occasion. But when the brain is still, a man can think properly. - Hippocrates, ~ 5 th Century B.C.

4. Circuitry of the Brain

5. ~100 billion neurons with ~ 200 trillion contacts between them

6. Pathology of Circuits

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

9. Seizures Vs. Epilepsy A seizure is a symptom (like a fever) - Infection, Traumatic Brain Injury, Electrolyte imbalance, drugs, nutritional, etc

10. Types of Seizures Classify by the brain areas involved (and EEG): – Partial Seizure: Arise from a delimited brain region Can be Simple (no impairment of awareness) or Can be Complex (have impairment of awareness) – Generalized Seizure Involves the whole brain Can have impaired awareness (Absence) or Can have motor involvement (Tonic-Clonic/Grand Mal)

11. Examples of Seizures:

12. Videos of Seizures: Absence Seizure: https://www.youtube.com/watch?v=BzIs8YeafZMhttps://www.youtube.com/watch?v=BzIs8YeafZM Gelastic Seizure: https://www.youtube.com/watch?v=ICvNGo2j-9Mhttps://www.youtube.com/watch?v=ICvNGo2j-9M Myoclonic Seizure: https://www.youtube.com/watch?feature=endscreen&NR=1&v=3epEL8sX-PM https://www.youtube.com/watch?feature=endscreen&NR=1&v=3epEL8sX-PM (As part of a a syndrome: Dravet Syndrome: Severe Myoclonic Epilepsy of Infancy) Tonic-Clonic Seizure (Grand Mal): https://www.youtube.com/watch?v=83UvqwJoStchttps://www.youtube.com/watch?v=83UvqwJoStc

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

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

18. Medical Management: Drugs Most anti-epileptics affect channels or neurotransmitters: – Sodium, Calcium, Chloride, GABA

19. Medical Management: Drugs 60-70% of patients can be successfully treated – Generalized seizures typically easier to control than partial seizures – Can consider weaning medication if seizure free (except in certain cases) Most common cause of treatment failure is noncompliance

20. When All Else Fails: Brain Surgery Options: – Focal resection: (I will focus on this) – Hemispherectomy – Partial Corpus Callosotomy Selection Criteria: – Refractory to medical therapy ( failed 3 or more drugs with different mechanisms of action) – Imaging suggests progressive disorder

21. 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

22. Current surgical techniques only ~ 20 years old: Why? – High resolution MRI, EEG, ECoG, Cortical Stimulation Surgical Techniques

23. Localizing Seizures: Cortical Stimulation Mapping

24. Localizing Seizures: Electrocorticography (ECoG)

25. Research Opportunities: Unparalleled opportunity to study brain function: – Intracranial electrodes offer the best of EEG and fMRI to Identify and study the eloquent cortex Making surgery safer for future patients – What NOT to cut!

26. Functional Brain Mapping

28. Functional Connectivity

29. Brain Computer Interface (BCI) “Woman with Quadriplegia Feeds Herself Chocolate Using Mind-Controlled Robot Arm” – https://www.youtube.com/watch?v=C7H_M8-dBHc

30. Questions?

51. Treatments: