1. Can all epilepsy patients be treated with surgery?
The majority of the remaining 30% to 40% can be treated with surgery through preoperative evaluation.
2. Which patients need surgical treatment?
(1) Drug therapy is ineffective.
(2) Drug therapy has high side effects.
(3) Clear intracranial epileptogenic foci.
3. Why should surgery be performed as soon as possible?
The longer the duration of the seizure, the worse the surgical outcome and the more severe the damage to neurointelligence.
4. What is an epileptic pathological focus?
The underlying lesions that cause epilepsy are epileptic foci, such as softening foci after traumatic brain injury, intracranial tumors, various cortical dysplasias and vascular malformations.
5. How many epilepsy patients in China need surgery to treat?
The prevalence of epilepsy in China is about 0.7%, and there are about 10 million epilepsy patients nationwide, of which 3-4 million are drug-refractory epilepsy, of which more than 2 million can be treated by surgery.
6. What is pre-operative evaluation?
Pre-operative evaluation is a number of tests that need to be done before surgery to clarify the site of the epileptogenic focus and the relationship between the epileptogenic focus and the functional area, and to adopt different surgical treatment plans according to the results of the evaluation.
7. What are the preoperative assessments (pre-surgical examinations)?
The basic tests are two: video EEG and epilepsy imaging (CT, MRI). If the basic tests cannot answer the question of the location of the epileptogenic focus and the relationship between the epileptogenic focus and the functional area, one or more of PET, MEG (magnetoencephalography), FMRI (functional magnetic resonance), and even intracranial electrodes are required in a few patients.
8.What is the purpose of preoperative evaluation?
The purpose of the preoperative evaluation is to clarify the type of epilepsy, the location of the epileptogenic focus and the relationship between the epileptogenic focus and the functional area, to determine whether surgery is appropriate and to guide the selection of the specific surgical approach.
9. Is it possible to operate without preoperative evaluation?
No. Surgery is absolutely not possible without preoperative evaluation. If the site of the epileptogenic focus and the relationship between the epileptogenic focus and the functional area are not clear, surgery cannot be performed.
10. Do all the tests need to be done before surgery?
The basic tests are two: video EEG and epilepsy imaging (CT, MRI), both of which are required for every epilepsy patient. electrode examination.
What is the purpose of the pre-surgical neuropsychological examination?
This test can determine the level of verbal IQ, operational IQ and total IQ of the epileptic patient.
(1) It can also distinguish more accurately the dominant side of the cerebral hemispheres for language and movement, as well as the distribution of memory function areas.
(2) To determine the degree of alteration in the patient’s intellectual disability, cognition, and behavior.
(3) To assist in the localization and analysis of epileptogenic foci in patients with epilepsy.
(4) as one of the criteria for selecting the surgical approach to epilepsy
(5) and to determine the outcome and possible complications after epilepsy surgery based on the patient’s IQ level.
12. Is pre-surgical neuropsychological examination necessary?
Because of the important role of the above neuropsychological examination, neuropsychological examination is necessary before surgery.
13.Is the neuropsychological examination still necessary for the post-surgical review?
It can be compared with the results of neuropsychological examination before surgery, and it can be used as a supplementary standard to evaluate the efficacy of epilepsy surgery, and it can also propose a reasonable rehabilitation plan based on the results of this examination, so neuropsychological examination is also necessary during the postoperative review.
14. What are epileptogenic foci?
The epileptogenic lesions (e.g., soft necrotic foci, tumors, etc.) and their surrounding epileptogenic cortex are collectively referred to as epileptogenic foci.
What are functional areas?
The area of the cerebral cortex that has a function clearly recognized by humans is the functional area, as opposed to the “dumb area” of the cortex. Currently, we refer to the functional areas as motor areas, sensory areas, motor language areas and language integration areas.
What are the possible relationships between epileptogenic foci and functional areas?
The relationship between epileptogenic foci and functional areas can be divided into the following four types: distant, adjacent, partially overlapping, and fully overlapping. If the foci are distant, the surgery will not affect the function; if they are adjacent, careful operation will not affect the function; if they are partially or fully overlapped, they will affect the function, and after surgery, there will be different degrees of compensation depending on the age at the time of surgery.
17.What should patients and families know before surgery?
They should know the location of the epileptogenic focus, whether there is any function in this location, the way of surgery, whether the epileptogenic focus will be completely cut, whether the surgery will have any effect on the function, and how much the surgery will affect the function and how much recovery is possible after surgery. Whether to adjust the medication after surgery, how to adjust the medication after surgery, etc.
18.What is intracranial electrode placement surgery?
If the site of the epileptogenic focus and/or the relationship between the epileptogenic focus and the functional area cannot be clarified by non-invasive examination, intracranial electrode placement surgery should be performed. The intracranial electrode placement procedure is a surgical procedure in which electrodes of different sizes are placed directly on the surface of the brain and/or deep target areas of the brain to directly record the epileptic discharges in the area where the electrodes are placed.
19. Is intracranial electrode placement surgery expensive?
The intracranial electrode placement procedure itself is not expensive, but the electrodes used for EEG monitoring are more expensive, especially the imported electrodes are more expensive.
20.What kind of patients need intracranial electrode placement surgery?
If the site of the epileptogenic focus and/or the relationship between the epileptogenic focus and the functional area cannot be clarified by non-invasive examination, intracranial electrode placement surgery is required.
21.Is intracranial electrode placement a curative procedure?
Intracranial electrode placement is not a therapeutic procedure. It is an invasive procedure that involves the placement of electrodes into the skull to clarify the location of the epileptogenic focus and the relationship between the epileptogenic focus and the functional area.