Epilepsy surgery
History
Definition
• Seizure
• Convulsion
• Epilepsy
Epidemiology
• Prevalence : 52,000,000 around the world
• 700,000 in Iran
Pathophysiology
• Developmental pathology of brain
• Neuronal and glial disorders
• Kindling phenomenon
• Reorganization of cortical tissue in response to hypoxia
Kindling phenomenon
Treatment
• Standard : monotherapy by antiepileptic drugs
• Traditional : phenobarbital , phenytoin , primidone , carbamazepine , valproic acid
• New : lamotrigine , topiramate , levatiracetam ,…
Failure of medical therapy
• Misdiagnosis • Irregular follow up• Irregularity in treatment• Life style factors• Brain tumors• Sever traumatic brain injury
Refractory epilepsy
•30 % of patients
Causes of refractory epilepsy
• Temporal lob epilepsy : the most common• Neuronal structural disorders • Inflammatory disorders• Autoimmune mechanisms • Tumors and sever traumatic brain injuries
Temporal lobectomy and lesionectomy
Callosotomy
Indications
• Tuberos sclerosis
• Infantile spasm
• Lenox – Gustaut syndrome
Hemispher - ectomy , tomy
Rasmussen's encephalitis
Multiple subpial transection
Vagal nerve stimulation
Mechanism
• Nor epinephrine
• GABA
• Reticular activating system
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