Epilepsy is a chronic disease of the nervous system (brain), characterized by repeated, unprovoked seizures.
The seizure is caused by abnormal electrical activity in the brain.
According to the World Health Organization (WHO), around 50 million people worldwide suffer from this disease, of which 10.5 million are children. The worldwide prevalence is approximately 0.8%.
The disease can be caused by genetic factors, infectious diseases (such as meningitis and encephalitis), problems with pregnancy and childbirth, brain injury and developmental disorders (cerebral cortex).
Most children with this condition can live "normal and healthy" lives. In a large proportion of the pediatric population, epilepsy develops benignly and responds to medication. However, there are 30% of patients who are unable to control seizures and are indicated for surgery or alternative options such as vagus nerve stimulation (VNS), ketogenic diet, or hormone treatments.
Let's consider some of them.
The primary treatment for a patient with epilepsy should always begin with an antiepileptic drug (AED). The purpose of these drugs (AED) is to be discontinued by the trial. This treatment does not cure epilepsy, it does not address the cause of the attacks, but it does correct the symptoms. Currently, this treatment is 70% effective in patients with epilepsy, but side effects of drug use are common.
However, we often find that seizure control is very difficult in patients with refractory epilepsy (RE) or drug insensitivity. It occurs when there is no control over the disease for several years and after 3 or more different antiepileptic drugs have been tried. In these cases, surgery becomes the main alternative to maximize effectiveness over other treatments.
Surgery for epilepsy may be an option when medications do not control the attacks, a condition known as drug-resistant epilepsy or resistant epilepsy. The goal of surgery for epilepsy is to treat or limit seizure severity with or without medication. The Rousset Institute of Epilepsy uses two surgical methods of treatment: diagnostic and therapeutic.
Diagnostic surgical procedures include advanced monitoring technologies where conventional diagnostic methods fail to identify the area of the brain where seizures are occurring in a patient. Diagnostic procedures include
SEEG is a three-dimensional method for diagnosing attack sites by inserting electrodes on tiny wires into the brain through small holes in the skull. Electrodes can accurately detect electrical activity deep in the brain and areas of the brain that trigger seizures.
These electrodes are visually controlled by the ROSA robot. Using brain imaging and ROSA, surgeons can pinpoint areas for safe and accurate electrode placement.
Patients who undergo a 3-4 hour minimally invasive SEEG procedure generally recover quickly and remain in the clinic for 1-2 weeks and are monitored.
Mesh implantation. Sometimes patients need to place electrodes on the surface of the cerebral cortex to determine the source of seizures. This involves the placement of a thin silicone letter with electrodes that can detect brain activity using Electrocorticography (ECoG). The procedure is useful when planning an upcoming surgery. The electrodes are left in place for 1 to 2 weeks to record electrical activity and map the brain. They are removed during a second surgery, which also includes the removal of the epileptic focus.
Surgical procedures aimed at treating seizures are known as therapeutic operations. These range from minimal-access laser procedures, involving the implantation of devices to stop attacks, to the removal of tissue that generates, or detaches, the seizures causing seizures from another part of the brain. These therapeutic operations fall into three categories:
For patients in whom seizures are triggered by a specific area of the brain, this area can be surgically removed or deactivated. A procedure known as focal resection.
Temporal lobe resection (also known as temporal lobectomy) is a procedure often used in which the part of the temporal lobe of the brain that is responsible for seizures is removed. Resection of the temporal lobe often cures or significantly reduces the number and severity of attacks. Studies show that 60-70% of patients do not experience seizures after this operation. This intervention is generally well tolerated and requires a short hospital stay. The operation lasts approximately 4:00, followed by a 3-day hospital stay and a 4-6-week recovery period.
Laser interstitial thermotherapy (LITT) (another type of resection) - uses a laser to inactivate the brain tissue that causes seizures. This minimally invasive surgical treatment is intended for some patients in whom seizures are triggered by a small area of the brain.
During LITT, a tiny hole is made in the skull. After that, the laser wire under the control of MRI is directed to the area of the brain where seizures are generated. Turning on, the laser is directed to the pathological area to neutralize seizures.
LITT is less invasive than other surgical treatments. It provides patients with faster and easier recovery. The 6-8 hour treatment procedure is performed under general anesthesia, and the patient can usually leave the clinic the next morning.
But not all patients are candidates for LITT. It is important that the patient undergoes examination at a center that offers not only LITT but also other surgical interventions for resection.
Modulation is the use of an electrical device to deactivate areas of the brain that are causing a seizure by directing a small amount of current into that area without removing or damaging the brain tissue. These treatments include:
- vagus nerve stimulation (VNS)
- reactive nerve stimulation (RNS) and
- deep brain stimulation (DBS).
Vagus nerve stimulation (VNS) is performed by attaching an electrode to the vagus nerve in the neck. The other end of the electrode is connected to a small stimulator located under the skin of your chest. The automatic stimulator emits a light electrical signal that turns on and off throughout the day. This stimulation reduces the ability of an attack to spread and usually results in a significant reduction in the frequency and severity of attacks.
VNS surgeries are widely used to treat epilepsy and have low risk and minimal side effects. The procedure reduces the number and severity of seizures, but is not a cure for epilepsy. The best candidates for this treatment are usually patients who cannot undergo surgery to completely stop their seizures.
VNS is performed under general anesthesia on an outpatient basis and usually takes 1 to 2 hours. Patients can return to their daily activities within 1 to 2 weeks.
Reactive Nerve Stimulation (RNS) is a revolutionary treatment option for adult patients with early epilepsy who have failed at least two anticonvulsants and are not candidates for resection.
Reactive stimulation uses a battery-powered device similar to a pacemaker that monitors electrical brain waves and responds to brain activity similar to attacks 24 hours a day. The device is implanted in the skull and connected to electrodes placed in the brain. If the electrodes detect the onset of an attack, small pulses of electrical current are directed to that part of the brain and block the development or spread of the attack. Patients must undergo a wide range of examinations to determine where the seizures originate in the brain.
RNS surgery is performed under general anesthesia and usually takes 2-4 hours. Patients stay in the clinic for 1-3 days and can return to daily activities soon after discharge.
Deep Brain Stimulation (DBS) is a new treatment that is designed to relieve judgment. DBS involves the implantation of electrodes in a deep region of the brain known as the thalamus, which is responsible for sensory perception and motor regulation. These electrodes are connected to a stimulating device placed under the skin of the chest. A device, similar to a pacemaker, sends electrical impulses to the thalamus to block the spread of seizures.
DBS surgery is performed under general anesthesia and usually lasts 3:00. Patients stay in the clinic for a short time and can return to their daily life after 4-6 weeks.
The shutdown operation is designed to turn off the "active" parts of the brain to stop the spread of seizures. The procedure reduces the severity of seizures, but does not completely eliminate them.
Disconnections include:
- splitting the main link between the two hemispheres of the brain to prevent attacks from moving from one hemisphere to the other. Performed in patients with severe generalized epilepsy (seizures affecting both hemispheres of the brain).
- multiple cuts (MST): a procedure aimed at preventing the spread of attacks in the brain while maintaining vital brain functions. MST involves a series of small surgical incisions in the brain tissue to turn off seizure impulses.
The Epilepsy Surgical Treatment Program at the Russi Epilepsy Institute, Quirónsalud, Spain, has a high international reputation for excellence in epilepsy research and its latest treatment and patient care.
It is imperative that each patient is examined by a multidisciplinary team of specialists, including a neurologist, neurosurgeon, neuropsychologist, neuropathologist, as well as a radiologist to determine the type of surgery (if any) and the most effective method of treatment. Each patient being considered for surgery participates in a rigorous evaluation that includes sophisticated testing and tests to determine if surgery is the best treatment option.
In some cases, surgery is not possible. Seizures may be triggered from multiple areas of the brain, or the risk of damage to brain function may be too high. In these situations, other treatment options are available.
New treatments for epilepsy are constantly being developed, and it may be possible to participate in clinical trials of a new drug or other new therapy for epilepsy.
The Russi Epilepsy Institute, Quirónsalud, Spain is a comprehensive, self-contained epilepsy treatment center. We have the latest and most advanced diagnostic methods. We provide all treatment options for epilepsy, both therapeutic and surgical.
Our activity began in 1987, and since then we have performed 832 diagnostic tests and performed more than 600 operations (1987 - 2013)
Our mission is to provide the best care and treatment for patients with epilepsy. Our mission is to improve the quality of life of our patients by improving our diagnostic and treatment strategies.
The team consists of representatives from various fields of health, specializing in epilepsy, neurologists, neurophysiologists, neuropsychology, neurosurgeons, nurses and support technical staff.
Professional practice history:
Academic education:
Let us know, and we will help you find best solution
the service works from9:00 to 21:00no break and weekend
