New study techniques improve Epilepsy Surgery outcomes.

-33Rd Annual Symposium of advances in epilepsy. Organized by the Epilepsy Surgery Undad

– from year ago and means, patients candidates for Epilepsy Surgery, can be studied with information that provide depth electrodes

This and other matters on various subjects related to the surgery are discussed every year at the Symposium on advances in epilepsy, led by Dr. Francisco Villarejo, Chief of service of neurosurgery del Hospital Infantil Universitario Niño Jesús.

The edition of this year, which took place Friday, March 9 at the hospital, and under the title “Challenges in the treatment of refractory epilepsy in children”, dealt with the pathophysiology and the new therapeutic targets in refractory epilepsy in children, the technical advanced neurophysiological and new borders in resective and not resective epilepsy surgery.

One of the objectives of this traditional Symposium has been understanding and analysis of the results of the surgery, which in many cases are improved through the application of technology in the medical field. In this sense, must highlight how adaptations have provided brain mapping and location, in particular, of the zone epileptogenic thus treated with surgery to more númeor of patients and achieve better results in the treatment.

One of the key tests in the phase of study prior to the intervention involves the placement of electrodes that allow to locate the area epileptogenic and dispose of part of the information that is used to analyze then the real possibilities of intervention. The study of records that are achieved thanks to these electrodes is one of the fundamental tools when making the decision of whether or not the intervention.

For years, and with this objective, has been the placement of the electrodes surface, located on the scalp, and subdural, placed on the surface of the brain, electrodes after craniotomy in the operating room.

Currently and since year ago and half in Hospital Infantil Universitario baby Jesus, through the use of new technological applications is providing emergency relief to patients who previously have them has placed electrodes deep, allowing the registration of certain crises that occur in areas far from the outermost part of the brain.

This type of electrodes offers very precise and concrete information on the pathology malformativa, impossible to register with those used previously information.

80% Of these patients, diagnosed with dysplasia of bottom of Groove has not returned to have seizures after the intervention.

Epilepsy, chronic neurological disease most prevalent

Epilepsy is a chronic neurological enferemdad of higher prevalence, after the migraine. Third of new diagnoses are done before the patient reaches 18 years. Head injuries, infections of the central nevioso system and cerebral vascular problems are the main risk factors that can trigger epilepsy.

The life of the patient with severe epilepsy and his family can radically improve after the surgery. There are “relating epileptic syndromes surgically”, in which the early surgery is the best or the only therapeutic option.

In childhood is associated with very often to mental impairment, and the quality of life. Today 70% of the epilepsy It is controlled with pharmacological treatments. For the rest of the cases, epilepsy surgery is envisaged as an alternative.

However, not all cases are likely to be treated surgically. Before making the decision, the patient undergoes a meticulous pre-surgical evaluation which involves the realization of different technical and psychological tests, to know the origin of the crisis, causing injury to the crisis, identify and confirm whether there is a cerebral functional deficit zone and its relation to the area of origin of the crisis and the injury, perform a mapping of the brain with subdural electrodes, as well as define deficit risks after the intervention.

of epilepsy surgery is developed and institutionalized in all Western countries from several decades ago.

Surgery unit of the Hospital child Jesus

In the year 2001, in Hospital Infantil Universitario Niño Jesús, began the Protocol to use Tutelado of the Agency for the evaluation of health technologies (coordinated by OSTEBA) for appropriate utilization of the epilepsy surgery. It was the first Spanish Center which developed a specific program for pediatric patients.

Its implementation was underway: the design and the definition of a complex methodology, the acquisition of a complex technological equipment, which includes the most advanced magnetic resonance techniques, and specific training of a medical group that performs the diagnosis, evaluation, treatment and its subsequent follow-up.

Pre-surgical evaluation of possible candidates for Epilepsy Surgery includes the identification of the area responsible for the crisis and the determination of the possible deficit associated with the removal according to the results of the assessment, if the patient is determined, or not, surgery, and the type of appropriate surgical resection candidate.

Hospital Niño Jesús assesses around 100 cases, that twenty, approximately just being treated surgically.

After the intervention, patients hold a medical follow-up of form legalized during several years as average 3 years to evaluate results, and removal or reduction of antiepileptic medication.

Organization and team

The programme is carried out with a multidisciplinary team, which is composed by the current Chief of service of neurosurgery, two optional specialists in clinical neurophysiology, with specific training in child epileptología and epilepsy in children surgery, which are responsible for the development of the phases of study, and the realization of studies of monitoring video – EEG; a neuroradiologist, a Neuropsychologist, the collaboration of the team of Neurology and five professional nursing. All of them with specific training in epilepsy surgery.