Epilepsy surgery, neurophysiology including intraoperative monitoring, seizures and pregnancy, women's health issues in epilepsy
Patients with epileptic seizures that do not respond to antiepileptic medications frequently undergo epilepsy surgery. The aim of surgery is to safely remove the diseased tissue in the brain that is responsible for the seizures. However, in patients with normal MRI or multiple abnormalities it is often difficult to identify the seizure onset zone. Routine diagnostic tests for identification are video/EEG monitoring, injection of a radioactive tracer during a seizure (ictal SPECT), neuropsycholgical testing and various other tests.
In this study we will try to identify whether MRI shortly after a seizure could be an additional, useful test to identify the seizure onset zone. Another aim of this study is to determine whether MRI with contrast could possibly replace ictal SPECT with its use of more harmful radioactive tracers.
Patients are routinely admitted to the epilepsy unit at DHMC for video/EEG monitoring. Patients usually undergo a routine clinical MRI with contrast prior to admission to the hospital. Patient stays are generally five to ten days, during which time they are monitored and their seizures are recorded on video. Ictal SPECT is routinely performed with radioactive tracer injected during a seizure.
This study will use the same protocol but the patient will receive an injection of gadolinium, the less toxic MRI contrast, during the seizure. Immediately after the seizure and again 24 to 48 hours thereafter MRIs will be performed. The study will not interfere with their routine clinical surgical workup or prolong their admission. The major risk will be two additional MRI scans.
This study involves the use of microelectrode recording in patients undergoing iEEG for surgical treatment of medically refractory epilepsy, and has two concurrent goals. One is to augment the standard iEEG recording with additional microelectrode recording which may help to identify regions of epileptogenic cortex. The second goal is to augment our ability to predict the cognitive risk of epilepsy surgery and investigate the role of the specific brain region in cognition and behavior. We utilize a commercially available, FDA approved, dual micro-macro electrode system. Our hypothesis is that such recording will elucidate specific characteristics of brain regions with epileptogenic potential, will offer novel insights into cognitive neuroscience, and help to predict neuropsychological outcomes of surgery.
"The Next Generation of Human Cortical Exploration"
Human Subdural Micro/Macro Single Unit Recording
Provides a method of measuring the electro-physiological responses of a single neuron in humans.