For drug-resistant epilepsy, surgery is often the only way to stop seizures. However, in frontal lobe epilepsy, surgery may not reliably stop seizures. A new study reveals a connection in the brain that explains why some frontal lobe surgeries are more effective in stopping seizures in the long term.
Epilepsy, one of the most common neurological disorders, affects approximately 50 million people worldwide. Frontal lobe epilepsy is a common form of epilepsy characterized by brief seizures that usually occur during sleep.
Drug therapy or drug-resistant epilepsy (also called uncontrolled, refractory, or refractory epilepsy) is usually treated with surgery to remove the part of the brain that is having seizures. Surgery is most effective when seizure activity is confined to one location. However, less than 30% of epileptic patients who undergo frontal lobe resection for seizures that begin there remain seizure-free in the long term.
Researchers at University College London looked for answers to this question by examining the frontal lobes of patients who had previously undergone a frontal lobeectomy.
After analyzing MRI scans of 47 patients who underwent frontal lobe surgery between 2007 and 2021, the researchers found that long-term seizure-free behavior was associated with neural pathways connecting the frontal lobe to the thalamus and striatum. found to be associated with the disconnection of of the brain.
The thalamus is an egg-shaped structure in the center of the brain that is the relay station for all incoming motor and sensory information. It also plays a role in keeping us awake and is connected to the brain’s limbic system, which processes and regulates emotions, forms and stores memories, and is involved in learning. The striatum, a collection of structures such as the caudate, putamen, and nucleus accumbens, is best known for facilitating voluntary movement, but also plays a role in the brain’s reward system.
The researchers found that patients with severance of this particular neural pathway were 88% and 80% seizure-free at 3 and 5 years, respectively, compared to the typical outcome of frontal lobectomy. bottom. Importantly, the surgery did not adversely affect the patient’s language or executive function, a range of mental skills including working memory, flexible thinking, and self-control.
These findings go a long way toward explaining why ablation works for some people and not for others, researchers say.
“Neurosurgery is very effective for patients with epilepsy that cannot be controlled with medication,” said Davide Giampiccolo, the lead author of the study. “However, in some patients, seizures recur years after surgery, and until now it was unclear why this occurred. I think it may be related.”
Identifying and “disconnecting” problematic parts of the frontal lobe network not only prevents epileptic seizures, but also leads to more effective and individualized neurosurgical treatments, researchers say.
“This will allow us to redesign neurosurgery, personalize the procedure for each patient, and ensure that the right connections are broken,” said Giampiccolo. “We hope this will significantly improve the long-term outcomes of epilepsy surgery.”
The researchers plan to use a larger cohort of patients to confirm their findings.
The study was published in a journal brain.
Source: University College London
