Famous Case Histories in Neurotrauma by Jessica Matyas

Author:Jessica Matyas [Jessica Matyas]
Language: eng
Format: epub
Publisher: Taylor and Francis
Published: 2021-01-15T00:00:00+00:00

Alternative Treatments

While treatment options for severe, treatment-resistant epilepsy are still comparatively small in number, the identification of less obvious seizures such as absence seizures has greatly improved in the decades since Henry’s surgery, as have techniques for identifying the points of origins for generalized seizures. As in the majority of other conditions, there is likely not going to be any single cure-all for epilepsy. Instead, treatments should be considered on a case-by-case basis based on the age of the individual, their types and frequencies of seizure, and responsiveness to medication. New and less-sedating medications are now available to help manage seizure severity, and trained support animals can readily identify a coming seizure so that their human can get to safety or take emergency medication before onset. If these options still fail, a few specialized surgical options remain available.

Focal Resection. Henry’s medial temporal lobectomy is considered to be a form of resection, albeit a very broad rather than focal one. Still, the resection of brain tissue was effective for a number of people even in Henry’s cohort if held to smaller and more specific areas. In order to determine the point of origin for Henry’s seizures, his doctors utilized electroencephalogram (EEG) recordings as well as pneumoencephalograms, contrast x-rays of the brain that visualize oxygen as it travels through the cerebrospinal fluid canals. One potential issue with this is that whole-brain EEGs tend to measure an overall level of activity over a shallow portion of the entire cortex, rather than showing specific regions of activity spikes. More modern methods have added in the use of intracranial EEGs, or measurements of activity from within the brain rather than over the scalp. While significantly more invasive than scalp electrodes, intracranial EEG is able to detect regional spikes such as high-frequency oscillations and fast ripples, providing a more thorough estimate of the seizure onset zone (Akiyama et al., 2011). Paired with direct cortical stimulation, or the stimulation of specific brain zones to detect their function (used often to locate language areas so as not to damage them during surgery), the target area can be planned ahead of time, and the offending area resected with minimal damage. Initial testing showed promising trends in relieving patients’ worst seizures; follow-up studies have observed few major complications as a result of the intracranial EEGS, the most common being CSF leak, which resolves itself over time, and following the resection itself, minor visual field interruptions that may not be readily noticed unless pointed out through neurological testing (Hader et al., 2013). Such side effects and others are, of course, necessary to discuss, but do not tend to be severe enough to discard focal resection as a therapeutic option. If there is a possibility for seizure-free life, many would take the smaller risk rather than continue on less effective management techniques. Yet for those who still find the removal of brain tissue aversive, there are other viable surgical options available.

The ‘Split-Brain’ Procedure. Initially characterized by van Wagenen in 1940, the so-called

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