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Epilepsy Surgery: Current Standards, Future Directions

Epilepsy Surgery: Current Standards, Future Directions

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Werner Doyle, MD Werner Doyle, MD Presentation Transcript

  • EPILEPSY SURGERY:
    CURRENT STANDARDS
    FUTURE DIRECTIONS
    Werner Doyle, MD
    Associate Professor Department of Neurosurgery
    NYU Langone Epilepsy Center
  • EEG used to monitor brain processes (brain function)
    Normal
    Complex
    Chaotic
    Seizure
    Simple
    Rhythmic
  • Surgical Methods
    Resection (craniotomy)
    Disconnection (MST, callosotomy)
    Alteration
    chemical / drugs
    electrical stimulation
    magnetic stimulation
    other (experimental)
    Local (direct)
    Diffuse (less direct)
    Open loop (fixed duty cycle)
    Closed loop (responsive)
    View slide
  • CURRENT STANDARDS
    Cranial Surgery
    View slide
  • Multiple SubpialTransections
  • CURRENT STANDARDS
    Vagus Nerve Stimulation
    65% of patients achieve 50% or greater reduction in seizure frequency
  • Vagus Nerve Stimulation
  • Benefits / Outcome
    Surgical outcome
    Stroke & Hemorrhage = 1%
    Infection = 3.5%
    Quality of life
    Cognition
    Driving
    Daily activities
    Family life
    Work
    School
    Sports & recreation
    Neurological Status
    Side effects
    Memory
    Cognition
  • Risk / Benefit
    Risk
    Benefit
    Seizure risks
    Seizures
    No surgery
    No surgery
    Surgery
    Surgery
    Surgical risks
    No seizures
    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
  • Probably available in the very near future
    Responsive VNS
  • DBS : Deep Brain Stimulation – possible near future
  • Future Surgical Directions
    Indirect drug (intrathecal) application
    Direct drug application
    Cortical cooling
    Opto-genetic
    Other . . .
  • Summary
    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