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J. Nicole Bentley, Cindy Chestek, William C. Stacey and Parag G. Patil

freedom from seizures at 2 years. 26 However, not all patients experience seizures emanating from the mesial temporal lobe, and of those that do, not all are candidates for resection. Therefore, there is a continued need for therapies that address focal epilepsies currently not amenable to existing techniques. There are two general approaches to controlling seizures. The first approach, which is the basis of most antiepileptic medications, is to alter the excitability of the neural network to prevent seizures from ever occurring. This pharmacological approach has led

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Kiran F. Rajneesh and Devin K. Binder

E pilepsy associated with PBTs causes seizures in 20–45% of patients, and tumor-associated epilepsy significantly decreases quality of life. 20 These seizures typically manifest as focal seizures with secondary generalization and are commonly refractory to antiepileptic drug treatment. The underlying pathophysiological characteristics of seizures secondary to brain tumors are poorly understood. However, a variety of hypotheses have been proposed, including altered neuronal regulation and connections, deranged vascular permeability, abnormal BBB, and

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Ken R. Winston, Keasley Welch, John R. Adler and Giuseppe Erba

A lthough hemispherectomy is one of the most successful surgical treatments for intractable seizures, 2, 26 this procedure has earned a reputation for a high risk of morbidity 6, 20 and mortality. 7, 29 Complications have been reported in 18% to 33% of cases, 2 often appearing years after surgery. 1, 8, 9, 11, 15, 21, 51 In recent years, there has been a renewed interest in this operation and an apparent increase in the frequency with which it is being performed. 5, 34 Good control of epilepsy is to be expected if patients are selected appropriately, but

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J. Brian North, Robert K. Penhall, Ahmad Hanieh, Derek B. Frewin and William B. Taylor

C linical practice with anti-epileptic prophylaxis after craniotomy varies widely from unit to unit. Despite a large body of evidence suggesting that epilepsy can be minimized, there is no generally accepted pharmacological regimen for postoperative seizure prophylaxis. Since the introduction of phenytoin in 1938, it has become the most popular anticonvulsant agent because of its efficacy and relative freedom from serious side effects. 9, 11 However, a prospective and randomized study to establish the efficacy of prophylactic postoperative therapy has not yet

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Jared Fridley, Jonathan G. Thomas, Jovany Cruz Navarro and Daniel Yoshor

E pilepsy is a highly prevalent disorder that is a major cause of morbidity in patients throughout the world. Nearly 1% of the population suffers from epilepsy, with an annual incidence of 50/100,000 people. 40 In 60%–70% of epilepsy patients, treatment with antiepileptic medications results in seizure remission. 40 The remaining patients, in whom symptoms are refractory to medications, currently have relatively limited alternative treatment options. Perhaps the most effective option in patients with medically refractory epilepsy is resective epilepsy

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William F. Caveness, Arnold M. Meirowsky, Berkeley L. Rish, Jay P. Mohr, J. Philip Kistler, J. Daniel Dillon and George H. Weiss

T he relation of craniocerebral trauma to convulsive seizures was clearly recognized by Hippocrates (460–357 BC) in his treatise “Injuries of the Head,” for he noted that a wound of the left temporal region would cause convulsions on the right side of the body, and vice versa . 32 However, the complexity of this relationship is not yet understood. Physicians of the Renaissance made careful observations on head trauma in both acute convulsions and chronic epilepsy. 32 John Hughlings Jackson in the 19th century added precise details for the association

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Marie Bourgeois, Christian Sainte-Rose, Giuseppe Cinalli, Wirginia Maixner, Conor Malucci, Michel Zerah, Alain Pierre-Kahn, Dominique Renier, Elisabeth Hoppe-Hirsch and Jean Aicardi

hydrocephalus to gain a more complete picture of epilepsy in this population. Clinical Material and Methods Patient Population In the period between 1980 and 1990, the cases of 802 children with hydrocephalus who had been treated with ventricular shunts at the Hospital Necker—Enfants Malades were studied and followed. Hydrocephalus requiring placement of a cerebrospinal fluid (CSF) shunt was always diagnosed using computerized tomography (CT) and/or magnetic resonance (MR) imaging. The criteria used to determine the need for shunt placement included evidence of raised ICP in

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George A. Ojemann

I t is commonly accepted that the first report of the surgical treatment of medically intractable epilepsy was that published by Horsley 37 a century ago. Since that time interest in the subject has waxed and waned. The recent renewal of attention to the topic is indicated by two international conferences on the surgery of epilepsy, both held within 6 months, in 1985 and 1986; 18, 92 these followed a lapse of over a decade since the previous conference. 74 There are a number of reasons for this renewed interest. Perhaps the most significant influence has

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Isabelle M. Germano, Nicole Poulin and André Olivier

S eizures recur after surgery for temporal lobe epilepsy in 20% to 60% of patients. 3, 5, 8, 12, 20 Although epilepsy surgery is practiced in an increasing number of centers, the indications for and the risks and outcome of reoperation for temporal lobe epilepsy have not been well documented. Reoperation for epilepsy was first reported in 1954 by Penfield and Jasper. 13 Several more recent series have demonstrated the benefit of reoperation for recurrent seizures, 14 including those of temporal lobe origin; 3, 12, 20 25% to 52% of patients were seizure

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Thomas L. Ellis and Andrew Stevens

E pilepsy is a common chronic neurological disorder that affects 0.5–1% of the population. 30 More than one-third of all patients with epilepsy have incompletely controlled seizures or debilitating medication side effects in spite of optimal medical management. 40 , 65 , 68 Medically refractory epilepsy is associated with injury and death, psychosocial dysfunction, and significant cognitive impairment. 9 Treatment options for these patients include new AEDs, which may lead to seizure freedom in 7% of patients, 22 and resection, which is associated with