Transcript Document

EPILEPSY TREATED WITH GAMMA
KNIFE
EPILEPSY
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Epilepsy is a common chronic neurological disorder that is
characterized by recurrent unprovoked seizures.
It is a group of syndromes with vastly divergent symptoms.
Involves episodic abnormal electrical activity in the brain.
•Types of Epilepsy:
Febrile seizures
Benign Rolandic Epilepsy
Childhood Epilepsy
Juvenile Absence Epilepsy
Juvenile Myoclonic Epilepsy
Infantile Spasms
Lennox-Gastaut Syndrome
Reflex epilepsies
Temporal Lobe Epilepsy
Frontal Lobe Epilepsy
Progressive Myoclonic Epilepsy
Mitochondrial Disorders
Landau-Kleffner Syndrome
Ring Chromosome 20 Syndrome
Hypothalamic Hamartoma
WHAT’S THE COMMON FACTOR???
Treatment of Epilepsy
Medication
Implantation of a vagus nerve stimulator
Special diet
Neurological operations for epilepsy which can be either palliative or curative
A new alternative method of treatment has been introduced which uses Gamma
knife radiosurgery (using finely foccussed beams of radiation instead of using a
real surgeon’s knife)
It is a non-invasive procedure of treatment of epilepsy
Epilepsy patients with seizures resistent to medication are treated by GKS
It is mainly seen in the treatment of Mesial Temporal Lobe Epilepsy (MLTE)
May also be used in the treatment of hypothalamic hamartomas and hippocampal
sclerosis
It is also seen to be an effective treatment in pediatric epilepsy
EPILEPSY TREATED WITH GAMMA KNIFE
GAMMA KNIFE
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The gamma knife device contains 201 cobalt-60
sources of approximately 30 curies each
It is placed in a circular array in a heavily
shielded assembly.
The device aims gamma radiation through a
target point in the patient's brain.
The patient wears a specialized helmet that is
surgically fixed to their skull so that the brain
tumor remains stationary at target point of the
gamma rays.
Therefore it is also known as the stereotactic
surgery.
GAMMA KNIFE
Patients eligible for Gamma Knife therapy
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Mostly patients with seizures originating in the mesial temporal
lobe can undergo treatment with the Gamma Knife.
In initial evaluation a patient is fitted with electrodes and then
allowed to have typical seizures over several days, in a protected
environment. Physicians monitor brain waves and record patient
responses with video and audio.
Patients are deemed ineligible for surgery if seizures come from
multiple areas of the brain. If the seizures originate within either
the left or right temporal lobes (located on the sides of the brain),
and additional MRI scans verify the location, patients are potential
candidates for surgery.
Some patients need a second round of monitoring with
electrodes placed inside the skull to more precisely identify the
area of disorder.
Final testing to verify that the disorder affects only one side of
the brain, and not both, will determine the candidate’s eligibility.
ADVANTAGES
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More effective than surgical resection which has a
very high amount of risk factors
Has very rare side effects, often transient and easily
detectable
Less costly method
Can be considered as an alternative when very deep
seated and small lesions are present
Increased alertness, elevated mood, and greater
speech production ,positive effect on sleep patterns
in younger patients
PRE AND POST GAMMA KNIFE SURGERY
Side-effects of Gamma knife therapy
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Adverse effects were few and
consist of:
Headache
Nausea
Vomiting
Visual field deficits
CONCLUSION
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In patients with over 2 years of
follow-up, the overall rate of
seizure freedom was 81%, with
12%improved and 7% unchanged
GKS is a non-invasive procedure
which does not involve risks
associated with surgical resection.
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Gamma Knife surgery is mainly used in
those patients :
Who are resistant to medications
In patients who have very deep seated and
small lesions in the brain
In patients with localized epileptogenic
zones.
It is mainly effective in the treatment of
Mesial Temporal Lobe Epilepsies (MTLE).
SEARCH STRATEGY
KEYWORDS
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Epilepsy
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“Gamma knife”
DATABASES & SEARCH TOOLS
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A Database is a structured collection of
records or data. A computer database
relies upon software to organize the
storage of data.
A Search engine is designed to search
for information on the World Wide Web.
Information may consist of web pages,
images and other types of files. Some
search engines also mine data available in
newsgroups, databases, or open
directories.
PROCESS OF SEARCH
TYPES OF DATABASES
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ABSTRACT DATABASE:
A database comprising a collection of scholarly
abstracts.
FULL-TEXT DATABASE:
A database comprising of information source
from cover to cover full-text articles.
PATENT DATABASE:
A database which provides access to issued and
applied patents.
DATABASES WE USED
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ABSTRACT DATABASE:
Pubmed , since it is a key
database for healthcare
professionals.
FULL-TEXT DATABASE:
Ovid LWW, a leading
fulltext resource for
professionals and students
of medicine, nursing, allied
health and pharmacy
PATENT DATABASE:
Patentlens
SEARCH PROCESS
ABSTRACT DATABASE
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Pubmed:
Use Pubmed basic search. Use search MeSH = Epilepsy and
find 27 results. I selected the first result and narrowed the
search to major subheadings, namely:
Radiotherapy, Surgery and Therapy
I restricted the search to these subheadings and combined
another search term “gamma knife” by selecting the option
Send to Search Box with AND, and searched PubMed.
I got 53 results in all-out of which 2 are free full text and
16 are from Southern Medical University Library. I referred
to these 18 full text results to research for my topic.
Click on this link
FULL-TEXT DATABASE
Ovid LWW:
Firstly, we select the database
SMUJournal@Ovid. We choose the
Advanced Ovid Search and use the Title
field using epilepsy AND gamma knife, and
search to find 5 results.
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Select title
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Patentlens:
Use Structured Search to find patents
having epilepsy AND “gamma knife” in Title
field, but found zero results.
To broaden the search, find patents with
epilepsy AND “gamma knife” in Full-Text
to get 33 results.
RELEVANT CITATIONS
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PUBMED:
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Bartolomei F, Hayashi M, Tamura M, Rey M, Fischer C, Chauvel P, Régis J.
Long-term efficacy of gamma knife radio surgery in mesial temporal lobe epilepsy.
Neurology. 2008 May 6; 70(19):1658-63. Epub 2008 Apr 9.
PMID: 18401026 [PubMed - indexed for MEDLINE]
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Régis J, Scavarda D, Tamura M, Villeneuve N, Bartolomei F, Brue T, Morange I, Dafonseca D, Chauvel P.
Gamma knife surgery for epilepsy related to hypothalamic hamartomas.
Semin Pediatr Neurol. 2007 Jun; 14(2):73-9. Review.
PMID: 17544950 [PubMed - indexed for MEDLINE]
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Eder HG, Feichtinger M, Pieper T, Kurschel S, Schroettner O.
Gamma knife radio surgery for callosotomy in children with drug-resistant epilepsy.
Childs Nerv Syst. 2006 Aug; 22(8):1012-7. Epub 2006 Jun 13.
PMID: 16770617 [PubMed - indexed for MEDLINE]
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Grabenbauer GG, Ernst-Stecken A, Ganslandt O, Stefan H.
Gamma knife surgery in mesial temporal lobe epilepsy.
Epilepsia. 2005 Mar;46(3):457; author reply 457-9. No abstract available.
PMID: 15730549 [PubMed - indexed for MEDLINE]
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Dunoyer C, Ragheb J, Resnick T, Alvarez L, Jayakar P, Altman N, Wolf A, Duchowny M.
The use of stereotactic radio surgery to treat intractable childhood partial epilepsy.
Epilepsia. 2002 Mar; 43(3):292-300.
PMID: 11906515 [PubMed - indexed for MEDLINE]
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PATENTLENS:
1 US 2005/0049486 A1
patent application
Title:Method for performing stereotactic radiosurgery
THANK YOU
Presented by:
Aparajita
Kumar(43)
Archita
Gupta(42)
Other members:
Sangeet
Komal(38)
Wilanika M.
Bamon(37)