शैडोइंग अभ्यास: MRI-Negative Epilepsy - वीडियो के साथ अंग्रेजी बोलना सीखें

This is something that I have a passion for.

One of the things that, you know, myself and our entire epilepsy group, we really care about patients who have epilepsy.

And as I mentioned at the beginning, if you have lesional epilepsy, those patients generally tend to have better outcomes.

And part of the reason for that is that we know if you have a lesion that we're focusing on that area.

We know that we're looking around that area for potentially the seizure onset zone.

But what happens when a patient comes in and they have a completely normal MRI?

Well, that makes it a much more difficult patient to treat.

And we know in the literature that those patients have a much lower rate of seizure freedom.

And so I'm going to talk a little bit about

my own personal thoughts on that and what we've done at UCI to minimize that.

So I like to start by doing a thought experiment.

So if you were to imagine what the ideal patient is for epilepsy surgery, you know, what I think about when I would hear something like that,

I would imagine a picture like this.

I would imagine a young patient, because we know younger patients tend to do better with the surgery.

I would think about someone who had a recent seizure onset, because if we know that if you've had a more recent seizure onset,

you're more likely to become seizure free.

And then I would also say that, you know, all the non -invasive tests all point to one area.

And if I was talking about an ideal patient, I would say that area would be the right temporal lobe, because we know that the right temporal lobe is probably the safest area for us to operate in,

generally tends to have the lowest risk for cognitive decline, some other types of neurocognitive issues that can be developed.

And the last part would be someone who has a significant decline in their nonverbal memory already.

The reason I put that in there is because on the right temporal lobe, that's where your nonverbal memory is.

And so oftentimes, things like patterns, knowing directions, those things are very important for patients.

And if you already come in and you have a significant decline, then by us doing surgery, it's very unlikely that you're going to get worse.

And so, you know, with this type of an ideal patient, if we do surgery on this patient, our likelihood of becoming seizure -free is about 75 to 80%.

It's really one of the best surgeries we have for patients with epilepsy.

Now, what's happening across the country and really across the world is that our actual surgical patients are looking more like this.

So pretty much the exact opposite of the patient I just talked about.

They may have a normal MRI.

They have their older patients.

They've had a longstanding history of seizures, which we know is a risk factor for less likely to become seizure -free with our surgery.

When we do scalp EEG, we may see bitemporal epilepsy, which is, again, a bad prognostic factor, means you're less likely to become seizure -free.

and then you know they may have discordant non -invasive studies

so again as I mentioned before you may have a PET

and a MEG and other types of studies

which all point to different parts of the brain and when

that happens then you know we see that the seizure -free

patients like this who we do surgery on the seizure -free

likelihood is actually in the range of 40 to 50 percent

so almost half of the patients you know compared to that other group can become seizure -free.

And this was a really interesting study done a few years ago from my old program at the Cleveland Clinic,

where they actually looked at patients who go to level four epilepsy centers like UCI, and they compared looking at the most,

you know, the ideal patient, that mesial temporal sclerosis versus any other type of patient.

And what we're seeing across the board, and again, across the world, is that those patients, that number of patients is steadily decreasing over time.

So we're not seeing these mesiotemporal sclerosis patients, the patients who are easy to treat and the ones who have the highest likelihood of seizure freedom.

We're actually seeing a lot more of this very difficult to treat patients that I just mentioned.

So really the question becomes, how do we improve the outcomes?

How do we take a patient with a normal MRI

and all these difficult findings and then try and make them closer to that ideal patient that I mentioned earlier.

So, well, the first thing you should do is basically look at what are the similarities

and what are the differences between these two subgroups of patients.

When you look at the MRI negative group, what you see is that they have a variety of pathologies.

And that right there is a very difficult, that right there makes it very difficult because

various pathologies are known to have different seizure -free outcomes depending on the surgery that you do.

With MRI negative temporal lobe epilepsy, you also see a greater rate of secondary generalization.

So what that means is that their brains are already wired in such a way

that they have a seizure in one area, but that quickly generalizes to the rest of the brain.

And so it's even more important in those patients that you accurately and definitively localize where those seizures are coming from.

The ictal onset zone for those patients with MRI negative temporal lobe epilepsy can often be the temporal lobe plus another area, and we call that temporal plus.

You can have neocortical epilepsy, which means like from the surface of the brain or some of the gray matter on the cortical surface,

or you may have bilateral or contralateral onset from where you think it's coming from.

And as I mentioned before, you see that those seizure -free rates are fairly low.

Now, when you look at the patients who have mesial temporal sclerosis, you see that they have clear hippocampal sclerosis,

which is a great prognostic, again, 70 to 80%.

They have classic semiology, their EEG correlates with the MRI, their ictal onset is coming from that hippocampus or the mesial temporal lobe.

And so pretty much no matter what you do, you can do laser ablation you can do open surgery you

have very good seizure free rates like i said 70 to 80

so when i look at this and when you

when you think about where these seizures what you know what the differences are

and what the main you know similarities are i really focus on

that ictal onset zone that's really the most important area for us in terms of how we localize these seizures

and how we can treat these patients hey everyone ryan rad here from neurosurgery training .org

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शैडोइंग अभ्यास: MRI-Negative Epilepsy - वीडियो के साथ अंग्रेजी बोलना सीखें

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