CURRENT STANDARDSFUTURE DIRECTIONS

EPILEPSY SURGERY:

Werner Doyle, MDAssociate Professor Department of NeurosurgeryNYU Langone Epilepsy Center

ComplexChaotic

SimpleRhythmic

EEG used to monitor brain processes (brain function)

Normal

Seizure

Resection (craniotomy)Disconnection (MST, callosotomy)

Alterationchemical / drugselectrical stimulationmagnetic stimulationother (experimental)

Open loop (fixed duty cycle)Closed loop (responsive)

Local (direct)Diffuse (less direct)

Surgical Methods

CURRENT STANDARDS

Cranial Surgery

Multiple SubpialTransections

CURRENT STANDARDS

Vagus Nerve Stimulation

65% of patients achieve 50% or greater reduction in seizure frequency

Vagus Nerve Stimulation

Benefits / Outcome

CognitionDriving

Daily activitiesFamily life

WorkSchool

Sports & recreation

Neurological Status

Side effectsMemory

Cognition

Surgical outcomeStroke & Hemorrhage = 1%Infection = 3.5%

Quality of life

Risk / Benefit

Surgery Surgery

No

surgeryNo

surgery

Risk

Benefit

Seizures

No seizures

Seizure risks

Surgical risks

Seizure risks >= Surgical risks Surgical Sz control >> Non-surgical Sz control

Probably available in the very near future

Responsive Neurostimulation (RNS) – in FDA approval process

RNS : NeuroPace

FUTURE DIRECTIONS : RNS

Responsive VNS

Probably available in the very near future

DBS : Deep Brain Stimulation – possible near future

Direct drug application

Indirect drug (intrathecal) application

Opto-genetic

Cortical cooling

Future Surgical Directions

Other . . .

Today : Surgery is available, relatively safe and very effective - Limitation is what can safely be resected

Near future : increased the number of people who are candidates for surgery using reversible augmenting techniques such as responsive stimulation

Distant future : other less invasive, non-destructive and reversible techniques such as opto-genetics and direct drug delivery

Summary