Transcript Epilepsy - Neurobowe

Epilepsy:
Insights into Consciousness
Obligatory Historical Quote:
“Men ought to know that from the brain… madness
comes from its moistness.
When the brain is abnormally moist, of necessity it
moves, and when it moves neither sight nor hearing are
still…
But when the brain is still, a man can think properly.
- Hippocrates, ~ 5th Century B.C.
Circuitry of the Brain
• ~100 billion neurons with ~ 200 trillion
contacts between them
Pathology of Circuits
Seizures Vs. Epilepsy
• A seizure is a symptom (like a fever)
Definitions:
• Seizure:
– A time-limited and involuntary alteration in behavior,
accompanied by an abnormal electrical discharge in
the brain.
Uncontrolled, excessive, and hyper-synchronous discharge of
cortical neurons
• Epilepsy:
– The tendency to have recurrent, non provoked
seizures.
Classify seizures into different types of disease
Types of Seizures
• Classify by the brain areas involved (and EEG):
– Partial Seizure:
• Arise from a delimited brain region
• No impairment of awareness = Simple
• Impairment of awareness = Complex
– Generalized Seizure
• Involves the whole brain
• Only impaired awareness = Absence
• Includes motor involvement = Tonic-Clonic/Grand Mal
Videos:
https://www.youtube.com/watch?v=BzIs8YeafZM
https://www.youtube.com/watch?v=83UvqwJoStc
Localizing Seizures:
• Aura:
– Visual: See spots, stars, blobs, etc
• Occipital cortex
– Auditory: Hear music, voices, ringing, etc
• Superior temporal cortex
– Olfactory: Smell burning, etc
• Uncinate cortex
– Fear:
• Amygdala
– Sexual: Erotic feelings, inappropriate arousal
• Medial Temporal lobe
Treatment
• Acute Management
• Long-Term Management (Drugs)
• Surgical Management
Medical Management: Drugs
• 60-70% of patients can be successfully treated
– Can consider weaning medication if seizure free
(except in certain cases)
• Most drugs affect ion-channels or
neurotransmitters:
– Sodium, Calcium, Chloride, GABA
• Most common cause of treatment failure is
noncompliance
When All Else Fails: Surgery
• Selection Criteria:
– Refractory to medical therapy ( failed 3 or more
drugs with different mechanisms of action)
– Imaging suggests progressive disorder
Surgical Options
• It’s scary, but:
– Consider the alternatives:
• Living in constant risk: Driving, Heights, Water,
Fire/Burns, Tools, etc.
– In Texas must be 6 months seizure free to drive
Localizing Seizures:
Electrocorticography (ECoG)
Research Opportunities:
• Unparalleled opportunity to study brain function
• Making surgery safer for future patients
What NOT to cut!
Functional Brain Mapping
Functional Brain Mapping
Multi-Modal Analysis
…And
Cool
Videos
Brain Computer Interface (BCI)
• “Woman with Quadriplegia Feeds Herself
Chocolate Using Mind-Controlled Robot Arm”
– https://www.youtube.com/watch?v=C7H_M8-dBHc
Questions?
Treatments: