Our Summary

Epilepsy is a common neurological disorder that affects around 50 million people around the world. While medication can help control the condition in some people, around 30-40% of patients with a specific type of epilepsy (partial epilepsy) don’t respond to medication. For these patients, epilepsy surgery can be an effective treatment.

To plan for this surgery, doctors use a range of techniques to understand which parts of the brain are affected during a seizure. This is known as a presurgical evaluation. In some cases, they need to use invasive methods to record electrical activity in the brain. This process can be time-consuming and relies heavily on the experience and judgment of the neurologist.

Despite these efforts, around 30% of surgeries are not correctly diagnosed, and the causes of over a third of all epilepsies are not well understood. In response to this, researchers are investigating the use of computer-based techniques to help improve diagnosis accuracy.

In recent years, a type of artificial intelligence known as deep learning has shown promising results in many areas of biology and medicine. However, it hasn’t been widely used in epilepsy evaluation yet.

This paper reviews how automatic applications, such as those based on deep learning, can be used in epilepsy to analyze human movement, brain electrical activity, and the relationship between the physical structure of the brain and the symptoms of epilepsy. The paper also looks at how these techniques can help identify the specific areas of the brain responsible for epilepsy.

The authors propose that future research should focus on using these techniques to improve the assessment of epilepsy surgery, particularly by combining visual observations of patient behavior during seizures with recorded brain electrical activity.

FAQs

  1. What is the current method for presurgical evaluation of epilepsy and its limitations?
  2. How does the misdiagnosis rate in epilepsy surgery affect the need for improved diagnostic precision?
  3. What potential does deep learning have in improving the diagnosis and treatment of epilepsy?

Doctor’s Tip

A doctor may advise a patient undergoing brain surgery to follow post-operative care instructions carefully, including getting plenty of rest, taking prescribed medications as directed, attending follow-up appointments, and avoiding activities that could put strain on the surgical site. It is important to communicate any concerning symptoms or changes in health to the medical team promptly.

Suitable For

Patients who are typically recommended for brain surgery include those with epilepsy who are nonresponsive to medication, as well as those with brain tumors, vascular malformations, traumatic brain injuries, and other neurological conditions that cannot be effectively treated with non-surgical interventions. The decision to recommend brain surgery is based on a thorough evaluation of the patient’s medical history, symptoms, diagnostic test results, and overall health status. The goal of brain surgery is to improve the patient’s quality of life and reduce the risk of complications associated with their neurological condition.

Timeline

Before brain surgery:

  1. Patient experiences seizures and seeks medical evaluation.
  2. Patient undergoes noninvasive tests such as video monitoring, neuroimaging, and electrophysiological tests to determine the location and extent of the epilepsy.
  3. In some cases, invasive intracranial recordings such as stereoelectroencephalography (SEEG) may be necessary to accurately map the eloquent brain networks involved during a seizure.

After brain surgery:

  1. Patient undergoes surgery to remove or disconnect the epileptic focus in the brain.
  2. Patient may experience a recovery period in the hospital, with monitoring of seizures and overall neurological function.
  3. Patient may require rehabilitation or physical therapy to regain any lost functions or improve overall quality of life.
  4. Patient continues to be monitored by medical professionals to ensure the success of the surgery and manage any potential complications.

What to Ask Your Doctor

  1. What specific type of brain surgery is being recommended for my condition?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery process expected to take?
  4. What are the expected outcomes and success rates for this type of surgery?
  5. Will I need to undergo any additional tests or procedures before the surgery?
  6. How experienced is the surgical team in performing this type of procedure?
  7. Are there any alternative treatment options available?
  8. How will my quality of life be affected after the surgery?
  9. Will I need to take any medications or undergo additional therapies after the surgery?
  10. How long will I need to stay in the hospital after the surgery?

Reference

Authors: Ahmedt-Aristizabal D, Fookes C, Dionisio S, Nguyen K, Cunha JPS, Sridharan S. Journal: Epilepsia. 2017 Nov;58(11):1817-1831. doi: 10.1111/epi.13907. Epub 2017 Oct 9. PMID: 28990168