Seizures

Seizures

Introduction Seizures are sudden, uncontrolled electrical disturbances in the brain that can lead to various physical and cognitive symptoms. While some seizures are isolated incidents, recurrent seizures may indicate epilepsy or an underlying neurological disorder. Neurosurgical interventions play a crucial role in managing seizures that do not respond to medical treatment. Identifying the cause and appropriate treatment strategy is essential to improving the quality of life for affected individuals.

Types of Seizures Seizures are broadly classified into two categories:

1. Focal (Partial) Seizures: Originate in a specific area of the brain and can be further divided into:
   • Simple Focal Seizures: Do not cause loss of consciousness but may alter sensory perception, motor function, or emotions.
   • Complex Focal Seizures: Involve altered consciousness and may include repetitive movements (automatisms).
2. Generalized Seizures: Involve both hemispheres of the brain and include:
   • Tonic-Clonic (Grand Mal) Seizures: Characterized by convulsions, muscle rigidity, and loss of consciousness.
   • Absence (Petit Mal) Seizures: Short episodes of staring and unresponsiveness, commonly seen in children.
   • Myoclonic Seizures: Sudden, brief muscle jerks without loss of consciousness.
   • Atonic Seizures: Sudden loss of muscle tone, leading to falls.
   • Tonic Seizures: Sustained muscle contractions without convulsions.

Neurosurgical Causes of Seizures

• Brain Tumors: Growths within the brain can disrupt normal electrical activity, leading to seizures.
• Traumatic Brain Injury (TBI): Damage to brain tissue from head injuries can cause post-traumatic epilepsy.
• Cerebrovascular Disorders: Stroke, aneurysms, or arteriovenous malformations (AVMs) can lead to seizures.
• Neurodegenerative Diseases: Conditions like Alzheimer’s disease may contribute to seizure activity.
• Cortical Dysplasia: Abnormal brain development can create seizure-prone regions.
• Infections and Inflammation: Meningitis, encephalitis, and autoimmune disorders affecting the brain can trigger seizures.

Diagnosis of Seizures A comprehensive evaluation is necessary to determine the cause of seizures and develop an appropriate treatment plan. Common diagnostic tools include:

• Clinical History and Neurological Examination: Assessing seizure patterns, triggers, and associated symptoms.
• Electroencephalogram (EEG): Measures electrical activity in the brain to detect abnormal patterns.
• Neuroimaging Studies:
  • MRI (Magnetic Resonance Imaging): Provides detailed images to identify tumors, cortical malformations, or structural abnormalities.
  • CT Scan (Computed Tomography): Helps detect hemorrhages or traumatic injuries.
• Video EEG Monitoring: Combines EEG with video recording to capture seizure events and determine their origin.
• Functional MRI (fMRI): Identifies brain regions involved in critical functions to guide surgical planning.
• Magnetoencephalography (MEG): Maps brain activity to locate epileptic foci.

Neurosurgical Approaches for Seizure Management When seizures are refractory to medication, neurosurgical intervention may be necessary. Common procedures include:

1. Resective Surgery: Removal of the seizure focus, commonly performed in patients with focal epilepsy.
   • Temporal Lobectomy: Often used for drug-resistant temporal lobe epilepsy.
   • Lesionectomy: Removal of tumors, AVMs, or cortical dysplasias causing seizures.
2. Corpus Callosotomy: Severing the corpus callosum to prevent the spread of seizures between hemispheres.
3. Deep Brain Stimulation (DBS): Implantation of electrodes to regulate abnormal brain activity.
4. Vagus Nerve Stimulation (VNS): A device implanted in the chest sends electrical impulses to the vagus nerve to reduce seizure frequency.
5. Responsive Neurostimulation (RNS): A neurostimulator detects and disrupts seizure activity in real time.
6. Hemispherectomy: A rare procedure involving the removal or disconnection of one cerebral hemisphere in cases of severe, drug-resistant epilepsy.

Conclusion:

Seizures can have a profound impact on an individual’s life, but advances in neurosurgical treatments offer hope for those with medication-resistant epilepsy. A thorough diagnostic approach, including neuroimaging and EEG studies, helps identify the best course of treatment. Neurosurgical interventions, ranging from resective surgeries to neurostimulation therapies, can significantly reduce seizure frequency and improve patient outcomes. Early diagnosis and intervention are key to enhancing the quality of life for individuals with seizure disorders.