Showing papers on "Epilepsy surgery published in 1983"

Characteristics of a Pure Culture of Frontal Lobe Epilepsy

Abstract: Forty patients with nontumoral epileptogenic lesions who have undergone cortical excision of portions of the frontal lobe for the relief of medically refractory focal epilepsy at the Montreal Neurological Institute during the period 1930-1971 have become and remained seizure free for a minimum period of 5 years (median follow-up 14 years). It seems logical to assume that, in these patients, the essential seizure-producing mechanisms were contained in the excised portions of the frontal lobe and such patients thus represent a pure culture of frontal lobe epilepsy. The clinical, radiological, EEG, surgical, and pathological findings were analyzed. The variability in the clinical pictures and EEG data gives ample testimony of the complex and varied patterns of spread of epileptiform discharges through the brain in patients with epileptiform lesions of the frontal lobe. The data presented also bear on two secondary localizational aspects of frontal lobe epilepsy: (a) how much cortex must be recruited into epileptiform discharge to produce recurring seizures, and (b) how much of the total potentially epileptogenic cortex must be removed to produce a satisfactory reduction of the seizure tendency. These data also emphasize the importance of improving the accuracy of our methods of evaluating these secondary and tertiary localizational aspects of epileptic phenomena.

Hemispherectomy--a modification.

Abstract: Hemispherectomy is probably the best operation for treating epilepsy. It was abandoned because of the delayed haemorrhagic complications that developed some years after the operation. A hypothesis is described to account for the mechanism of such complications and modifications made to the operative technique to prevent such complications. This modified hemispherectomy has been carried out on four patients since 1980.

The indications for and the role of depth electrode recording in epilepsy.

Abstract: A series of 47 patients studied with stereotactically implanted depth electrodes is analyzed. Indications and grouping of the patients fall into three main categories: (a) the bitemporal series (35 patients) where there is ambiguity as to the lateralization of the focus; (b) the unilateral series (6 patients) where the problem is one of localization within one hemisphere, and (c) the generalized series where one tries to determine the primary focus in secondary generalized seizures (6 patients). The best indication appears to be the bitemporal cases, in which a large number of attacks can be recorded by computer. Most of them tend to have a well-lateralized onset in one of the temporal lobes; 32 of the 35 implanted patients were operated upon (91.4%). The results on the seizure tendency in these patients is comparable, if not superior, to those obtained in the so-called unilateral cases. Correlation studies indicate that interictal activity is a good indicator of the predominance of seizures.

Neurosurgical Management of Epilepsy: A Personal Perspective in 1983

Abstract: The therapeutic goal in the neurosurgical treatment of medically intractable epilepsy is complete seizure control, for both biologic and psychosocial reasons. Cortical resections are more likely to accomplish this than other surgical alternatives for epilepsy. Although abnormalities on new imaging techniques (CT, positron emission scanning) aid in identifying the epileptic focus, interictal epileptiform EEG changes remain the main indicator of focal origin of the seizures. Where this is equivocal, direct brain recording of spontaneous seizures with subdural electrodes is of value in identifying the side and lobe of seizure onset. The cortical resection is then tailored by the extent of the interictal electrocorticographic abnormalities and functional identification of essential areas such as those for language, using an electrical stimulation mapping technique, under local anesthesia. With this approach, half of the patients with temporal lobe foci are seizure-free since the time of operation, over two-thirds become so with time, and over three-quarters have at least very major reductions in seizure frequency.

Psychosocial and cognitive function after commissurotomy for intractable seizures

Abstract: ✓ Cerebral commissurotomy appears to be an effective treatment for persons with severe epilepsy that has not responded to pharmacological treatment. Psychosocial and neuropsychological evaluation of eight patients who have received this surgical treatment suggests that patients who have an uncomplicated operative and postoperative course do not experience functionally significant intellectual, emotional, or social impairment. Limiting the operation to extraventricular division of the corpus callosum may significantly reduce postoperative morbidity. The authors suggest ethical guidelines which they believe should be carefully followed when epileptic patients are being considered for this type of surgery.

The role of surgery in epilepsy.

Abstract: Surgery for the reduction or elimination of seizures in epilepsy is not a new therapeutic technique. The criteria for surgical candidates have evolved over the past 40 years so that individuals with epilepsy are not subjected to surgery unless it is considered beneficial after careful evaluation of the patient’s condition. An intensive work-up by a multifaceted team at the Cleveland Clinic is performed for each patient referred for epilepsy surgery. Various techniques are considered and tailored for the individual. In the literature, the success rate for epilepsy surgery in markedly reducing or eliminating seizures is about 65%.