Werner Doyle, MD
-
Upload
nyu-faces -
Category
Health & Medicine
-
view
1.139 -
download
0
description
Transcript of Werner Doyle, MD
CURRENT STANDARDSFUTURE DIRECTIONS
EPILEPSY SURGERY:
Werner Doyle, MDAssociate Professor Department of NeurosurgeryNYU Langone Epilepsy Center
ComplexChaotic
SimpleRhythmic
EEG used to monitor brain processes (brain function)
Normal
Seizure
Resection (craniotomy)Disconnection (MST, callosotomy)
Alterationchemical / drugselectrical stimulationmagnetic stimulationother (experimental)
Open loop (fixed duty cycle)Closed loop (responsive)
Local (direct)Diffuse (less direct)
Surgical Methods
CURRENT STANDARDS
Cranial Surgery
Multiple SubpialTransections
CURRENT STANDARDS
Vagus Nerve Stimulation
65% of patients achieve 50% or greater reduction in seizure frequency
Vagus Nerve Stimulation
Benefits / Outcome
CognitionDriving
Daily activitiesFamily life
WorkSchool
Sports & recreation
Neurological Status
Side effectsMemory
Cognition
Surgical outcomeStroke & Hemorrhage = 1%Infection = 3.5%
Quality of life
Risk / Benefit
Surgery Surgery
No
surgeryNo
surgery
Risk
Benefit
Seizures
No seizures
Seizure risks
Surgical risks
Seizure risks >= Surgical risks Surgical Sz control >> Non-surgical Sz control
Probably available in the very near future
Responsive Neurostimulation (RNS) – in FDA approval process
RNS : NeuroPace
FUTURE DIRECTIONS : RNS
Responsive VNS
Probably available in the very near future
DBS : Deep Brain Stimulation – possible near future
Direct drug application
Indirect drug (intrathecal) application
Opto-genetic
Cortical cooling
Future Surgical Directions
Other . . .
Today : Surgery is available, relatively safe and very effective - Limitation is what can safely be resected
Near future : increased the number of people who are candidates for surgery using reversible augmenting techniques such as responsive stimulation
Distant future : other less invasive, non-destructive and reversible techniques such as opto-genetics and direct drug delivery
Summary