Epilepsy surgery: Difference between revisions
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{{CMG}} {{AE}} {{Fs}} | {{CMG}} {{AE}} {{Fs}} | ||
== Overview == | == Overview == | ||
Surgery is not the first-line treatment option for patients with epilepsy. Surgery is usually reserved for patients who their [[seizure]] continues to happen despite using maximum dosage of [[Anti-epileptic drugs|anti-seizure drugs]]. | [[Surgery]] is not the first-line treatment option for patients with epilepsy. [[Surgery]] is usually reserved for patients who their [[seizure]] continues to happen despite using maximum dosage of [[Anti-epileptic drugs|anti-seizure drugs]]. | ||
== Indication == | == Indication == | ||
Surgery is not the first-line treatment option for patients with epilepsy. Surgery is usually reserved for patients who their [[seizure]] continues to happen despite using maximum dosage of anti-seizure drugs.<ref name="pmid12528052" /> | [[Surgery]] is not the first-line treatment option for patients with epilepsy. [[Surgery]] is usually reserved for patients who their [[seizure]] continues to happen despite using maximum dosage of anti-seizure drugs.<ref name="pmid12528052" /> | ||
==Surgery== | ==Surgery== | ||
The goal of surgery in epilepsy can be divided into two categories: | The goal of [[surgery]] in epilepsy can be divided into two categories: | ||
* Curative | * Curative | ||
** Lesional resection | ** Lesional [[resection]] | ||
** [[Lobectomy]] | ** [[Lobectomy]] | ||
** Corticectomy | ** Corticectomy | ||
| Line 17: | Line 17: | ||
** Multiple subpial transactions | ** Multiple subpial transactions | ||
** [[Gamma knife|Gamma knife radiosurgery]] | ** [[Gamma knife|Gamma knife radiosurgery]] | ||
* Palliative | * [[Palliative]] | ||
** | ** Hemispheric [[surgery]] | ||
** Multiple subpial transections | ** Multiple subpial transections | ||
** Disconnection procedures such as [[callosotomy]] | ** Disconnection procedures such as [[callosotomy]] | ||
** Stimulation procedures including [[Vagus nerve stimulation|vagal nerve stimulation]] and [[deep brain stimulation]] | ** Stimulation procedures including [[Vagus nerve stimulation|vagal nerve stimulation]] and [[deep brain stimulation]]<ref name="pmid12528052">{{cite journal |vauthors=McKhann GM, Bourgeois BF, Goodman RR |title=Epilepsy surgery: indications, approaches, and results |journal=Semin Neurol |volume=22 |issue=3 |pages=269–78 |date=September 2002 |pmid=12528052 |doi=10.1055/s-2002-36653 |url=}}</ref> | ||
== Contraindications == | == Contraindications == | ||
[[Contraindication|Contraindications]] for [[Vagus nerve stimulation|vagal nerve stimulation]] includes: | [[Contraindication|Contraindications]] for [[Vagus nerve stimulation|vagal nerve stimulation]] includes: | ||
* [[Cardiac arrhythmia| | * [[Cardiac arrhythmia|Cardiac arrhythmias]] | ||
* | * Respiratory diseases such as [[asthma]] | ||
* [[Hoarseness]] | * [[Hoarseness]] | ||
* [[Peptic ulcer| | * [[Peptic ulcer|Gastric ulcers]] | ||
* [[vasovagal syncope]] | * [[vasovagal syncope]] | ||
* | * Previous left or bilateral cervical [[vagotomy]] | ||
* | * Progressive intracerebral disease <ref name="pmid11709642">{{cite journal |vauthors=Boon PA |title=Vagus nerve stimulation for refractory epilepsy |journal=J Clin Neurophysiol |volume=18 |issue=5 |pages=393 |date=September 2001 |pmid=11709642 |doi= |url=}}</ref> | ||
Contraindications for [[deep brain stimulation]] includes: | Contraindications for [[deep brain stimulation]] includes: | ||
* | * Unstable [[Heart diseases|heart disease]] | ||
* | * Active [[infection]] | ||
* | * Significant [[subcortical arteriosclerotic encephalopathy]] | ||
* [[malignancy]] with markedly reduced life expectancy | * [[malignancy]] with markedly reduced [[life expectancy]] | ||
* | * Abnormal findings on presurgical imaging (except for minor [[atrophy]])<ref name="pmid12774214">{{cite journal |vauthors=Landi A, Parolin M, Piolti R, Antonini A, Grimaldi M, Crespi M, Iurlaro S, Aliprandi A, Pezzoli G, Ferrarese C, Gaini SM |title=Deep brain stimulation for the treatment of Parkinson's disease: the experience of the Neurosurgical Department in Monza |journal=Neurol. Sci. |volume=24 Suppl 1 |issue= |pages=S43–4 |date=May 2003 |pmid=12774214 |doi=10.1007/s100720300039 |url=}}</ref><ref name="pmid16810718">{{cite journal |vauthors=Lang AE, Houeto JL, Krack P, Kubu C, Lyons KE, Moro E, Ondo W, Pahwa R, Poewe W, Tröster AI, Uitti R, Voon V |title=Deep brain stimulation: preoperative issues |journal=Mov. Disord. |volume=21 Suppl 14 |issue= |pages=S171–96 |date=June 2006 |pmid=16810718 |doi=10.1002/mds.20955 |url=}}</ref> | ||
==References== | ==References== | ||
Revision as of 15:20, 17 April 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Surgery is not the first-line treatment option for patients with epilepsy. Surgery is usually reserved for patients who their seizure continues to happen despite using maximum dosage of anti-seizure drugs.
Indication
Surgery is not the first-line treatment option for patients with epilepsy. Surgery is usually reserved for patients who their seizure continues to happen despite using maximum dosage of anti-seizure drugs.[1]
Surgery
The goal of surgery in epilepsy can be divided into two categories:
- Curative
- Lesional resection
- Lobectomy
- Corticectomy
- Hemispheric disconnection
- Multiple subpial transactions
- Gamma knife radiosurgery
- Palliative
- Hemispheric surgery
- Multiple subpial transections
- Disconnection procedures such as callosotomy
- Stimulation procedures including vagal nerve stimulation and deep brain stimulation[1]
Contraindications
Contraindications for vagal nerve stimulation includes:
- Cardiac arrhythmias
- Respiratory diseases such as asthma
- Hoarseness
- Gastric ulcers
- vasovagal syncope
- Previous left or bilateral cervical vagotomy
- Progressive intracerebral disease [2]
Contraindications for deep brain stimulation includes:
- Unstable heart disease
- Active infection
- Significant subcortical arteriosclerotic encephalopathy
- malignancy with markedly reduced life expectancy
- Abnormal findings on presurgical imaging (except for minor atrophy)[3][4]
References
- ↑ 1.0 1.1 McKhann GM, Bourgeois BF, Goodman RR (September 2002). "Epilepsy surgery: indications, approaches, and results". Semin Neurol. 22 (3): 269–78. doi:10.1055/s-2002-36653. PMID 12528052.
- ↑ Boon PA (September 2001). "Vagus nerve stimulation for refractory epilepsy". J Clin Neurophysiol. 18 (5): 393. PMID 11709642.
- ↑ Landi A, Parolin M, Piolti R, Antonini A, Grimaldi M, Crespi M, Iurlaro S, Aliprandi A, Pezzoli G, Ferrarese C, Gaini SM (May 2003). "Deep brain stimulation for the treatment of Parkinson's disease: the experience of the Neurosurgical Department in Monza". Neurol. Sci. 24 Suppl 1: S43–4. doi:10.1007/s100720300039. PMID 12774214.
- ↑ Lang AE, Houeto JL, Krack P, Kubu C, Lyons KE, Moro E, Ondo W, Pahwa R, Poewe W, Tröster AI, Uitti R, Voon V (June 2006). "Deep brain stimulation: preoperative issues". Mov. Disord. 21 Suppl 14: S171–96. doi:10.1002/mds.20955. PMID 16810718.