Epilepsy surgery: A therapeutic patient education program

Before the creation of a therapeutic patient education (TPE) program for epilepsy surgery, a needs analysis was conducted with 29 people, including patients (n = 13), family members (n = 9) and healthcare providers (n = 7). Most of them highlighted the psychological difficulties of the surgical process, and the need for considerably more precise information concerning the immediate postoperative period. In addition, several patients and/or family members requested meeting with a patient who had undergone the surgery. The majority of subjects were interested in epilepsy-surgery TPE. These data were important in the creation of our TPE program and, more generally, for the management of these patients.     

Prevalence of Epilepsy in Kelibia, Tunisia

A door-to-door survey was made in Kelibia, Tunisia to determine the prevalence of major neurologic disorders, including epilepsy. The survey was made according to a World Health Organization (WHO) protocol (1981). All individuals responding positively to the screening tool were examined by a neurologic team using well-defined diagnostic criteria. One hundred forty-one individuals, alive on prevalence day (July 1, 1985), were identified as having active epilepsy, giving a crude prevalence ratio of 4.04 per 1,000 and an age-adjusted (on WHO population) prevalence ratio of 3.64 per 1,000. Prevalence ratios increase with age (in children and young adults with the highest prevalence ratio at ～20 years) and decrease after 40 years. The most frequently identified type was generalized convulsive seizures (93%). The most frequently associated conditions were cerebral palsy and mental retardation.     

Epilepsy control program in India: a district model

Based on data originating from neuroepidemiologic studies in India, epilepsy has been identified as a public health problem. The treatment gap varies from 50 to 70% among persons with epilepsy and is compounded further by limited availability of neurologists, often working in urban metropolises, thus restricting the availability of services in a predominantly rural agrarian country. Cost-effective, sustainable epilepsy care programs are urgently required in India. To bridge this wide gap, a district model was developed with the central focus on training the district medical officers in providing epilepsy care with sensitization of state health administrators and nodal neurologists to support and sustain the program. Workshops were conducted for all three groups during the period 1999-2001, with the involvement of 21 state health administrators, 148 district medical officers, and 28 neurologists. Preliminary evaluation indicates a growing interest, enthusiastic commitment, and willingness among health professionals to expand epilepsy care to the periphery. The program revealed that it is possible to reach people with epilepsy on the premise of early diagnosis and management, need-based referral network, and a rational planning for uninterrupted availability of antiepileptic drugs along with education of families. Policy-level initiatives are required further to transform this on a wider scale and to evaluate the efficacy and effectiveness of this approach.     

Epilepsy surgery: Chance for a cure

Epilepsy is a chronic disorder with medical, as well as psychosocial, consequences. Many patients with epilepsy are well controlled by medication and are able to tolerate the side effects of the antiepileptic drugs needed to control their disorder. However, there are many people who are either unable to gain seizure freedom with medications or are intolerant of the side effects of their drugs. In some of these patients, particularly those with mesial temporal sclerosis, surgery offers a viable treatment alternative and a chance for a cure rather than just lifelong management.     

Epilepsy surgery in tuberous sclerosis: a systematic review

PURPOSE: Tuberous sclerosis complex (TSC) is often associated with intractable epilepsy. Although epilepsy surgery has gained interest in recent years uncertainties exist about which patients are good surgical candidates. A systematic review of the available literature has been undertaken to assess the overall outcome of epilepsy surgery and identify risk factors of seizure recurrence. METHODS: We searched MEDLINE, Embase, and bibliographies of reviews and book chapters to identify articles published in English since 1960. Twenty-five articles, describing postoperative seizure outcome and type of surgery in 177 TSC patients, were included in this study. Seizure outcome was analyzed both as seizure freedom and good outcome, including patients with >90% seizure reduction. RESULTS: Seizure freedom was achieved in 101 patients (57%). Seizure frequency was improved by > 90% in 32 patients (18%). Moderate or severe intellectual disability (IQ < 70) (RR 1.8; 95% CI 1.2-2.8) and the presence of tonic seizures (RR 1.7; 95 % CI 1.2-2.4) were related to seizure recurrence. CONCLUSIONS: A relation between multiple seizures types with early onset, multiple cortical tubers and multifocal epileptogenicity, and poor outcome is not supported by this systematic analysis. Although there is considerable variation among studies reviewed here, the literature suggests that resective surgery may offer benefit in a selected population of TSC patients with drug-resistant epilepsy.     

A state-university collaboration program: residents' perspectives

Little information is currently available about how residents perceive the recently developed state-university collaboration programs in psychiatry. To determine the opinions of residents participating in the collaboration program in Kentucky, the authors administered a questionnaire to 18 residents who had completed at least one rotation at Eastern State Hospital in Lexington. The questionnaire asked the residents to respond to statements about the clinical, organizational, and educational aspects of the experience. Most respondents rated the experience as favorable, and 78 percent indicated interest in state employment. In addition, the state hospital was noted as one of residents' three future career choices.     

Epilepsy surgery in China

Epilepsy surgery began in China from the 1950s to the 1960s, after the People's Republic of China was established (hereinafter as China). However, its rapid growth occurred in recent 10 years with the implement of reform and open policy. The growth is mainly manifested in basic and clinical aspects. As for clinical development, the qualities and quantities of epilepsy surgery have been to an increasing trend gradually. A survey undertaken by the China Association Against Epilepsy (CAAE) in June 2006 at the major six cities in different parts of the country showed a dramatic increase particularly in the years 2004 and 2006. Surgery for temporal lobe epilepsy accounts for half of the operation and it has played an important role in the treatment of the drug resistant epilepsy. With large population and vast geographical spread, it is important to further develop the service, especially for the pediatric epilepsy surgery in China, because the earlier operation for patients with real intractable epilepsy, the better outcome with seizure control and neuropsychologic recovery.     

Epilepsy surgery in children

Neurosurgical procedures of established value in the treatment of the medically intractable epilepsies include temporal lobectomy, extratemporal cortical excision, hemispherectomy, and corpus callosotomy. The clinical decision to consider surgery in children with epilepsy requires an understanding of the natural history of pediatric seizures, the constraints of the presurgical evaluation, and the relationship between surgical outcome and tissue pathology. This article presents an overview of the indications, risks, and benefits of epilepsy surgery in the pediatric population.     

Epilepsy surgery in infancy

Surgery for intractable epilepsy is being offered at progressively younger ages, including infancy. The most common causes of catastrophic epilepsy in very young surgical candidates are focal malformations of cortical development and low-grade tumors. Additional causes include Sturge-Weber syndrome, epidermal nevus syndrome, hemimegalencephaly, and prenatal or perinatal infarction. Many infants manifest with focal seizures, whereas some patients have infantile spasms in the setting of a focal epileptogenic lesion. Video electroencepholography, magnetic resonance imaging, and positron emission tomography are critical investigations to explore surgical options. In small series, the percentage of infants free of seizures after surgery was in the range of 60%. This is similar to that seen after epilepsy surgery in older children, adolescents, and adults. However, larger series with long-term follow up will be important. Furthermore, the extensive procedures required in infants for removal of the epileptogenic developmental lesions entail some risk, and should not be offered in the absence of severe epilepsy. Most infant candidates for epilepsy surgery have significant developmental delay. Few data are available, but anecdotal experience suggests that surgical relief of catastrophic epilepsy may result in resumption of developmental progression. For each infant, the timing of surgery must be carefully considered based on full assessment of the relative risks and benefits, derived from a detailed presurgical evaluation.     

Epilepsy surgery: Recommendations for India

The following article recommends guidelines for epilepsy surgery for India. This article reviews the indications, the various surgical options available and the outcome of surgery for drug resistant epilepsy based on current evidence. Epilepsy surgery is a well-established option for patients who have been diagnosed to have drug resistant epilepsy (DRE) (on at least two appropriate, adequate anti-epileptic drugs (AEDs) (either in monotherapy or in combination) with continuing seizures), where the presurgical work-up has shown concordance of structural imaging (magnetic resonance imaging) and electrical mapping data (electroencephalography (EEG), video EEG). There may be a requirement of functional imaging techniques in a certain number of DRE like positron emission tomography (PET), single photon emission tomography, (SPECT)). Invasive monitoring should be restricted to a few when all noninvasive investigations are inconclusive, there is a dual pathology or there is a discordance of noninvasive data. The types of surgery could be curative (resective surgeries: amygdalo hippocampectomy, lesionectomy and multilobar resections; functional surgeries: hemispherotomy) and palliative (multiple subpial transaction, corpus callosotomy, vagal nerve stimulation). Epilepsy surgery in indicated cases has a success range from 50 to 86% in achieving seizure freedom as compared with <5% success rate with AEDs only in persons with DRE. Centers performing surgery should be categorized into Level I and Level II.     

Cultural influences on the development of lateral preferences: a comparison between French and Tunisian children

We compared the development of laterality in two cultures that differ in pressure against left-handedness. Tunisian children, who are discouraged by their parents from using their left hand for all food-related activities, were compared to French children, who are allowed to use either the left or right hand. The subjects were 5, 7, and 9 years of age. To check the development of laterality, we tested hand preference (for writing and for performing 14 other manual activities), right-left performance difference, eye preference, and foot preference. The results showed that the frequency of left-handedness and left-eyedness was lower among Tunisian than among French children; this was particularly clear at age 5. Group difference almost disappeared in primary school children. Footedness did not differ between the two groups. Tunisian right-hand writers, although they probably included some children who might not have been right-handed without the cultural pressure, were not less consistent than French right-hand writers on the 14-item scale; they even showed a greater performance difference in favour of the right hand than the French on the pegboard task. These results may indicate that cultural pressure influences handedness at an early age, perhaps by leading towards right-handedness in children whose genetic background might otherwise have induced a chance-determined pattern of handedness.     

State-university collaboration in psychiatry: The pew memorial trust program

This contribution summarizes the background leading up to the goals of and the experience gained from a major national initiative to expand and improve collaborative activities between state departments of mental health and university departments of psychiatry through regional conferences, national workshops, ongoing consultations, and awards. It details the problems of the public system and how successful collaborative efforts have improved the situation, cites the role of one such a program (in Maryland), recounts the process of holding a national invitational conference and the subsequent Call to Action, and summarizes what the Pew Project is intended to do and how the project is progressing.Co-Principal Investigator, State-University Collaboration Project, Pew Memorial TrustProtions of this contribution were adapted fromCollaboration Between State Mental Health Administrations and Medical School Departments of Psychiatry-A Call to Action (Talbott, 1985),Working Together: State University Collaboration in Mental Health, (Talbott & Robinowitz, 1986a), andProposal to the Pew Memorial Trust, (Talbott & Robinowitz, 1986b).     

Voluminous hypothalamic hamartoma in a 5-month-old boy: Epilepsy and surgery

The authors report the case of 5-month-old boy with a hypothalamic hamartoma and persistent gelastic seizures in spite of a wide combination of different antiepileptic drugs. It was decided to carry out only partial removal of the tumor for decompression and to decreasing the activity of the epileptogenic focus. Surgical therapy revealed as a valid option in the treatment of the uncontrollable gelastic seizures.     

Promoting public-academic collaboration: The Ohio research fellows program

Conclusions Our experiences suggest the viability of the Ohio Research Fellows approach to public-academic collaboration. This approach to research collaboration is appropriate for states with established research programs as well as state mental health departments with limited resources that may be reluctant to apply for other types of public-academic opportunities. Moreover, the Ohio Research Fellows Program approach may also be cited by administrators or policymakers who wish to advocate at the federal level for increased funding of a greater variety of state initiated approaches to public-academic liaison. Funds may be allocated to assist states in tailoring efforts at public-academic collaboration to their individual needs using aspects of the Ohio Research Fellows approach.     

Epilepsy and the inner city schools: a school-based program that makes a difference

A program was developed within the Baltimore City School System to comply with U.S. Public Laws 94-142 and 94-484. The program provided assessment, appropriate placement, counseling, work experience, and epilepsy education. Self-identified students were primarily black and poor, more likely to be either 1 year behind in reading or in special education. Seventy percent had psychosocial problems but for less than half were the problems directly related to seizures. The program decreased the nonpromotion rate and the dropout rate to less than half of that for the school system as a whole, and cut in half the percentage of youths who were unemployed or not in school or training 1 and 2 years after graduation. The per pupil cost was 10% greater than current expenditures for the system as a whole.     

Best practices: the consultation-liaison in primary-care psychiatry program: a structured approach to long-term collaboration

This column presents the Consultation-Liaison in Primary-Care Psychiatry model, which was developed in Australia. This model is a structured approach to collaborative care of people with mental illnesses between primary care services and specialist mental health services. The first component of the model is a consultation, liaison, and education service provided by psychiatric consultants at participating general practices. The second component involves transferring selected patients from community mental health services into general practitioner-based collaborative care. In the final component a clinical case-register and reminder system managed by the specialist services is used to actively promote follow-up for transferred clients. The column also offers some evidentiary support for this care model that suggests a best-practices model for maintaining adequacy of care for patients.