Epilepsy surgery
Experience at the Hospital de Clínicas de Montevideo
Keywords:
EPILEPSY SURGERY, REFRACTORY EPILEPSYAbstract
Epilepsy is one of the most frequent neurological disease. Surgical treatment is a proved alternative in selected patients that reject pharmacologic therapy.
Results depend on an adequate study algoritm, a multidisciplinary approach of the patient, an appropiate selection of surgical techniques and on neurosurgeon experience.
The paper analyzes the experience in the Surgical Programme of Epilepsy (Programa de Cirugía de Epilepsia, Instituto de Neurología, Hospital de Clínicas). From April 1999 to October 2004, 64 patients were assessed, 53 were diagnosed as having rejecting epilepsy for pharmacological treatment. All patients that fulfilled assessment and defined as surgical candidates with adequate functional post-surgical prognosis underwent surgical epilepsy.
Surgical procedures used in 15 patients were as follow: lesionectomía (cavernomas, tumours), resection of mesial temporal structures and one functional hemyspheroctomy.
Post-operatory follow-up (mean 23 months) showed a group of 7 patients crisis-free, and a group of 6 patients with significant decrease of crisis.
Preliminary experience has shown positive outcomes that support the development of highly specialized programmes in our country.
References
1) Universidad de la República. Instituto de Neurología. Sección Neuroepidemiología. Prevalencia de las Principales Enfermedades Neurológicas en la Villa del Cerro. Montevideo: Instituto de Neurología, 1995.
2) Lüders HO, Noachtar S, eds. Epileptic seizures: pathophysiology and clinical semiology. Philadelphia: Churchill Livingstone, 2000.
3) Gram L, Johannessen S, Sillanpää, Tomson T, eds. Intractable epilepsy. Hampshire: Wrightson Biomedical Publishing, 1995.
4) Shorvon SD, Hart YM, Sander JWAS, Andel F. The Management of Epilepsy in Developing Countries: an "icberg" manual. In: International Congress and Symposium Series Nº 175. Oxford: Royal Society of Medicine Services, Aden Press, 1991.
5) Lüders HO. Epilepsy surgery. New York: Raven Press, 1992.
6) Palmini A, Costa-da-Costa J. Seleçâo de candidatos à cirugia da epilepsia: à inseparàvel parceria entre conhecimento e bom senso. Arch Inst Neurol 1999; 2(3): 108-24.
7) Palmini A, Costa-da-Costa J, Calcagnotto ME, Martínez JV. Avaliaçao prè-cirurgica de pacientes com epilepsia parcial refrataria: papel da interaçao entre avanços tecnológicos y avanços conceituais. Arch Inst Neurol 1999; 2(3): 125-37.
8) Martin RC, Gilliam FG, Kilgore M, Faught E, Kuzniecky R. Improved health care resource utilization following video-EEG-confirmed diagnosis of nonepileptic psychogenic seizures. Seizure 1998; 7(5): 385-90.
9) Trenerry MR, Loring DW, Petersen RC, Sharbrough FW. The Wada Test. In: E. Wyllie. The treatment of epilepsy: Principles and practice. Baltimore: Williams & Wilkins, 1997:1000-5.
10) Wada J, Rasmussen T. Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance: experimental and clinical observations. J Neurosurg 1960; 17(2): 266-82.
11) Rowe CC. Nuclear medicine in the manegement of a patient with epilepsy. In: Murray IPC, Ell PJ, eds. Nuclear medicine in clinical diagnosis and treatment. 2nd ed. Edinburgh: Churchill Livingstone, 1998:651-65.
12) Grunwald F, Menzel C, Pavics L, Bauer J, Hufnagel A, Reichmann K, et al. Ictal and interictal brain spect imaging in epilepsy using technetium-99m-ECD. J Nucl Med 1994; 35(12): 1896-901.
13) Devous MD, Thisted RA, Morgan GF, Leroy RF, Rowe CC. Spect brain imaging in epilepsy: a meta-analysis. J Nucl Med 1998; 39(2): 285-93.
14) Zubal IG, Spanaki MV, MacMullan J, Corsi M, Seibyl JP, Spencer SS. Influence of technetium-99m-hexamethylpropylene amine oxime injection time on single-photon emission tomography perfusion changes in epilepsy. Eur J Nucl Med 1999; 26(1): 12-7.
15) Newton MR, Berkovic SF, Austin MC, Rowe CC, McKay WJ, Blandin PF. Postictal switch in blood flow distribution and temporal lobe seizures. J Neurol Neurosurg Psychiatry 1992; 55(10): 891-4.
16) Ardanaz J, Ferrando R, Barros A, Lago G, Cibils D. Basal ganglia hyperperfussion correlation with ictal dystonia in temporal lobe epilepsy. Clin Neurophysiol 2003; 114: 160.
17) Ferrando R, Ardanaz J, Barros A, Lago G, Cibils D. Lateralizing value of basal ganglia ictal hyperperfussion in temporal lobe seizures. Clin Neurophysiol 2003; 114: 163.
18) The Cleveland Clinical Foundation. Epilepsy surgery. Syllabi and abstracts. International Cleveland Clinic-Bethel Symposium, 9. Cleveland Ohio, June 22-26, 1998.
19) Burger PC, Scheithauer BW, Vogel FS. The brain: surgery for seizures. In: Burger PC, Scheithauer BW, Vogel FS. Surgical pathology of the nervous system and its coverings. 4th ed. Philadelphia: Churchill Livingstone, 2002:390-402.
20) Honavar M, Meldrum BS. Epilepsy. In: Graham DI, Lantos PL, eds. Greenfield’s neuropathology. London: Arnold, 2002:899-931.
21) Graever MB, Blakeriore WF, Kreutzberg GW. Cellular pathology of the central nervous system. In: Graham DI, Lantos PL, eds. Greenfield’s neuropathology. London: Arnold, 2002:123-92.
22) Estapé JM, Laca H. Un caso de epilepsia Bravais-Jackson. Rev Med Uruguay 1924; 27:157-62.
23) Schroeder A, Arana-Iñiguez R, Fuster B, San-Julián J. Contribución al tratamiento quirúrgico de la epilepsia. Actas Tercer Congreso Sudamericano de Neurocirugía (Buenos Aires). Arch Neurocir 1949; 6:243-75.
24) Schroeder A, Arana-Iñiguez R, Fuster B, San-Julián J. Contribución al tratamiento quirúrgico de la epilepsia. An Inst Neurol Montevideo 1949; 8: 7-48.
25) Arana-Iñiguez R, Queirolo C, San-Julián J. Hemisferectomía: a propósito de una observación. Arch Pediatr Urug 1957; 28: 145-54.
26) Arana-Iñiguez R, Rebollo MA, Sande MT. Hemisferectomías: a propósito de cuatro casos. Arch Pediatr Urug 1959; 30: 657-68.
27) Castells C, Gastaut H, Vigouroux R, Ferrer S. Etude des réactions desviationnelles au cours des crises temporales. Rev Neurol 1952; 86(6): 674-8.
28) Castells C, Maslenikov V. Automatismos ictales y epilepsias temporales. An Inst Neurol Montevideo 1956; 12: 67-90.
29) Fuster B, Gibbs EL, Gibbs FA. Psychomotor epilepsy. Arch Neurol Psychiatr 1948; 60: 331-9.
30) Bogacz J, Vanzulli A, Arana-Iñiguez R, Garcia-Ausst E. Complex Structure of Temporal Epileptiform Foci. Acta Neurol Latinoamer 1961; 7: 310-7.
2) Lüders HO, Noachtar S, eds. Epileptic seizures: pathophysiology and clinical semiology. Philadelphia: Churchill Livingstone, 2000.
3) Gram L, Johannessen S, Sillanpää, Tomson T, eds. Intractable epilepsy. Hampshire: Wrightson Biomedical Publishing, 1995.
4) Shorvon SD, Hart YM, Sander JWAS, Andel F. The Management of Epilepsy in Developing Countries: an "icberg" manual. In: International Congress and Symposium Series Nº 175. Oxford: Royal Society of Medicine Services, Aden Press, 1991.
5) Lüders HO. Epilepsy surgery. New York: Raven Press, 1992.
6) Palmini A, Costa-da-Costa J. Seleçâo de candidatos à cirugia da epilepsia: à inseparàvel parceria entre conhecimento e bom senso. Arch Inst Neurol 1999; 2(3): 108-24.
7) Palmini A, Costa-da-Costa J, Calcagnotto ME, Martínez JV. Avaliaçao prè-cirurgica de pacientes com epilepsia parcial refrataria: papel da interaçao entre avanços tecnológicos y avanços conceituais. Arch Inst Neurol 1999; 2(3): 125-37.
8) Martin RC, Gilliam FG, Kilgore M, Faught E, Kuzniecky R. Improved health care resource utilization following video-EEG-confirmed diagnosis of nonepileptic psychogenic seizures. Seizure 1998; 7(5): 385-90.
9) Trenerry MR, Loring DW, Petersen RC, Sharbrough FW. The Wada Test. In: E. Wyllie. The treatment of epilepsy: Principles and practice. Baltimore: Williams & Wilkins, 1997:1000-5.
10) Wada J, Rasmussen T. Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance: experimental and clinical observations. J Neurosurg 1960; 17(2): 266-82.
11) Rowe CC. Nuclear medicine in the manegement of a patient with epilepsy. In: Murray IPC, Ell PJ, eds. Nuclear medicine in clinical diagnosis and treatment. 2nd ed. Edinburgh: Churchill Livingstone, 1998:651-65.
12) Grunwald F, Menzel C, Pavics L, Bauer J, Hufnagel A, Reichmann K, et al. Ictal and interictal brain spect imaging in epilepsy using technetium-99m-ECD. J Nucl Med 1994; 35(12): 1896-901.
13) Devous MD, Thisted RA, Morgan GF, Leroy RF, Rowe CC. Spect brain imaging in epilepsy: a meta-analysis. J Nucl Med 1998; 39(2): 285-93.
14) Zubal IG, Spanaki MV, MacMullan J, Corsi M, Seibyl JP, Spencer SS. Influence of technetium-99m-hexamethylpropylene amine oxime injection time on single-photon emission tomography perfusion changes in epilepsy. Eur J Nucl Med 1999; 26(1): 12-7.
15) Newton MR, Berkovic SF, Austin MC, Rowe CC, McKay WJ, Blandin PF. Postictal switch in blood flow distribution and temporal lobe seizures. J Neurol Neurosurg Psychiatry 1992; 55(10): 891-4.
16) Ardanaz J, Ferrando R, Barros A, Lago G, Cibils D. Basal ganglia hyperperfussion correlation with ictal dystonia in temporal lobe epilepsy. Clin Neurophysiol 2003; 114: 160.
17) Ferrando R, Ardanaz J, Barros A, Lago G, Cibils D. Lateralizing value of basal ganglia ictal hyperperfussion in temporal lobe seizures. Clin Neurophysiol 2003; 114: 163.
18) The Cleveland Clinical Foundation. Epilepsy surgery. Syllabi and abstracts. International Cleveland Clinic-Bethel Symposium, 9. Cleveland Ohio, June 22-26, 1998.
19) Burger PC, Scheithauer BW, Vogel FS. The brain: surgery for seizures. In: Burger PC, Scheithauer BW, Vogel FS. Surgical pathology of the nervous system and its coverings. 4th ed. Philadelphia: Churchill Livingstone, 2002:390-402.
20) Honavar M, Meldrum BS. Epilepsy. In: Graham DI, Lantos PL, eds. Greenfield’s neuropathology. London: Arnold, 2002:899-931.
21) Graever MB, Blakeriore WF, Kreutzberg GW. Cellular pathology of the central nervous system. In: Graham DI, Lantos PL, eds. Greenfield’s neuropathology. London: Arnold, 2002:123-92.
22) Estapé JM, Laca H. Un caso de epilepsia Bravais-Jackson. Rev Med Uruguay 1924; 27:157-62.
23) Schroeder A, Arana-Iñiguez R, Fuster B, San-Julián J. Contribución al tratamiento quirúrgico de la epilepsia. Actas Tercer Congreso Sudamericano de Neurocirugía (Buenos Aires). Arch Neurocir 1949; 6:243-75.
24) Schroeder A, Arana-Iñiguez R, Fuster B, San-Julián J. Contribución al tratamiento quirúrgico de la epilepsia. An Inst Neurol Montevideo 1949; 8: 7-48.
25) Arana-Iñiguez R, Queirolo C, San-Julián J. Hemisferectomía: a propósito de una observación. Arch Pediatr Urug 1957; 28: 145-54.
26) Arana-Iñiguez R, Rebollo MA, Sande MT. Hemisferectomías: a propósito de cuatro casos. Arch Pediatr Urug 1959; 30: 657-68.
27) Castells C, Gastaut H, Vigouroux R, Ferrer S. Etude des réactions desviationnelles au cours des crises temporales. Rev Neurol 1952; 86(6): 674-8.
28) Castells C, Maslenikov V. Automatismos ictales y epilepsias temporales. An Inst Neurol Montevideo 1956; 12: 67-90.
29) Fuster B, Gibbs EL, Gibbs FA. Psychomotor epilepsy. Arch Neurol Psychiatr 1948; 60: 331-9.
30) Bogacz J, Vanzulli A, Arana-Iñiguez R, Garcia-Ausst E. Complex Structure of Temporal Epileptiform Foci. Acta Neurol Latinoamer 1961; 7: 310-7.
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Published
2006-03-31
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1.
de Epilepsia P de C. Epilepsy surgery: Experience at the Hospital de Clínicas de Montevideo. Rev. Méd. Urug. [Internet]. 2006 Mar. 31 [cited 2024 Nov. 24];22(1):36-45. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/782
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