Werner Doyle, MD

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Epilepsy Surgery: Current Standards, Future Directions

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Werner Doyle, MD

  1. 1. EPILEPSY SURGERY: <br />CURRENT STANDARDS<br />FUTURE DIRECTIONS<br />Werner Doyle, MD<br />Associate Professor Department of Neurosurgery<br />NYU Langone Epilepsy Center<br />
  2. 2. EEG used to monitor brain processes (brain function)<br />Normal<br />Complex<br />Chaotic<br />Seizure<br />Simple<br />Rhythmic<br />
  3. 3. Surgical Methods<br />Resection (craniotomy)<br />Disconnection (MST, callosotomy)<br />Alteration<br /> chemical / drugs<br /> electrical stimulation<br /> magnetic stimulation<br /> other (experimental)<br />Local (direct)<br />Diffuse (less direct)<br />Open loop (fixed duty cycle)<br />Closed loop (responsive)<br />
  4. 4. CURRENT STANDARDS<br />Cranial Surgery<br />
  5. 5. Multiple SubpialTransections<br />
  6. 6. CURRENT STANDARDS<br />Vagus Nerve Stimulation<br />65% of patients achieve 50% or greater reduction in seizure frequency<br />
  7. 7. Vagus Nerve Stimulation<br />
  8. 8. Benefits / Outcome<br />Surgical outcome<br />Stroke & Hemorrhage = 1%<br />Infection = 3.5%<br />Quality of life<br />Cognition<br />Driving<br />Daily activities<br />Family life<br />Work<br />School<br />Sports & recreation<br />Neurological Status<br />Side effects<br />Memory<br />Cognition<br />
  9. 9. Risk / Benefit<br />Risk<br />Benefit<br />Seizure risks<br />Seizures<br />No surgery<br />No surgery<br />Surgery<br />Surgery<br />Surgical risks<br />No seizures<br />Seizure risks >= Surgical risks<br />Surgical Sz control >> Non-surgical Sz control<br />
  10. 10. Probably available in the very near future<br />
  11. 11. Responsive Neurostimulation (RNS) – in FDA approval process<br />
  12. 12. RNS : NeuroPace<br />
  13. 13. FUTURE DIRECTIONS : RNS<br />
  14. 14. Probably available in the very near future<br />Responsive VNS<br />
  15. 15. DBS : Deep Brain Stimulation – possible near future<br />
  16. 16. Future Surgical Directions<br />Indirect drug (intrathecal) application<br />Direct drug application<br />Cortical cooling<br />Opto-genetic<br />Other . . . <br />
  17. 17. Summary<br />Today : Surgery is available, relatively safe and very effective - Limitation is what can safely be resected<br />Near future : increased the number of people who are candidates for surgery using reversible augmenting techniques such as responsive stimulation<br />Distant future : other less invasive, non-destructive and reversible techniques such as opto-genetics and direct drug delivery<br />

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