For individuals with drug-resistant epilepsy, surgical treatment may be an option if seizures are well-localized to a specific brain region. The identification of this area, known as the “seizure focus”, is based primarily on EEG recordings when patients are on the Epilepsy Monitoring Unit. In mesial temporal lobe epilepsy (mTLE), seizures arise from the hippocampus and surrounding areas in the mesial temporal lobe, typically on either the right or left side of the brain. Individuals with temporal lobe epilepsy often experience problems with memory and/or language function. In frontal lobe epilepsy (FLE), where seizures arise from the right or left frontal areas of the brain, a patient may have difficulties with “executive functions”, such as planning, working memory, and cognitive flexibility.
Previous studies have shown poorer outcomes after surgery when the seizure focus is outside of the temporal lobe, or if neuroimaging (such as MRI) is unable to identify any brain changes that might be contributing to seizures. In addition, partial or complete surgical removal of the temporal lobe carries a risk of post-surgical memory loss and/or language function. This can have a significant impact on quality of life, and can also affect an individual’s decision to undergo surgery. Similarly, surgical treatment of frontal lobe epilepsy can result in difficulties with working memory, attention, and other executive functions. Thus, assessing the risk of post-surgical complications is critical.
More recently, new techniques are allowing researchers to study the brain as a network in order to understand how the seizure focus affects function in other brain regions. These new neuroimaging techniques have shown a promising ability to provide better outcomes related to cognition. They can provide information in three important areas: 1) how language and memory networks may be affected by chronic seizure activity; 2) how these networks may be affected by new therapies; and 3) whether individual differences in brain activity are related to outcomes following surgery.
- To develop new techniques and new analyses to better characterize epileptic network activity, particularly in epilepsy patients without any noticeable changes in brain structure. This will result in improved seizure outcomes.
- To enhance methods to predict and potentially prevent difficulties with language, memory and cognition after surgery. This will improve quality of life for epilepsy patients.
- To identify genetic differences in patients with temporal and frontal lobe epilepsy. This may identify factors that can help to predict good surgical outcomes.
Enrolling by Invitation
A talk by Dr. Carter Snead
On December 9th, 2020, Dr. Carter Snead, an EpLink researcher and neurologist at the Hospital for Sick Children in Toronto, presented a virtual talk titled “Stories we Tell”. This talk discussed efforts by Snead and colleagues over the last eight years to transform epilepsy care for thousands of infants, children, and adults in Ontario. He also discussed Project ECHO and identifying epilepsy surgery candidates.
Watch the talk here: https://youtu.be/-vuoI7jt13k
I am one who has undergone 2 and a moderate probability for a third neurosurgery as I was once the worst case of epilepsy in North America for 6 years (1980-86) but still average 6-10 tonic clonics a month. The late, historical dr. Frederick Andermann was overwhelmed by my case deeming me as the worst case in his career. (1986 emergency patient as I was truly having 20-30 tonic colonic and 200-300 complex partials a day) he first thought it was fictional but with my mother as an RN and my sister as a neuroradiologist my family knew medical diagnosis. I even have wrote a book as I was the first severely disabled allowed the rights to an education. It was my mother that got the ball rolling for special needs after bill 82 was passed. I then wrote a book to psychologically assist some who have trouble coping with mental and/or physical problems as I have as you must always look at things with a positive attitude.