“I am an epilepsy patient and I suffered from grand mal seizures for close to 32 years. At the age of one I had a severe inner ear infection, leading to pneumonia, which resulted in a convulsion. At the time, doctors and my family did not know that this incident caused damage to my left temporal lobe. This was the beginning of having grand mal seizures. Over the years the seizures became so frequent and severe where it made it virtually impossible for me to do anything on my own…Since my surgery at The Neuro, I have been completely seizure free and I am off all medication… Patient Donna Blair’s full story
The Neuro has been at the forefront of epilepsy treatment and research for over half a century. In the 1950s, Dr. Wilder Penfield and his colleagues developed the "Montreal Procedure", operating on awake patients in order to pinpoint the source of their epilepsy. In this way, Penfield was able to identify, in most cases, the precise location of the source of the seizure activity and remove or destroy that bit of tissue to end the patient's seizures. People suffering from epilepsy from around the world traveled to The Neuro for this new surgery which Penfield performed more times than any other neurosurgeon in the world. His work brought him and The Neuro international recognition. This tradition continues with multidisciplinary teams at The Neuro exploring all aspects of epilepsy from genetics to automated lesion detection in drug resistant epilepsy.
Advances in treating drug-resistant epilepsy:
Nearly one-third of epilepsy patients suffer from seizures that do not respond to drug treatments, making surgery the only effective treatment for these individuals. More than 90% of patients enjoy an improved quality of life, seizure-free, once the brain lesion associated with the epilepsy is removed. Finding the lesion, though is often the most difficult part as they can be tiny and undetectable, even with MRI. In a new review published in Nature Reviews Neurology, researchers at The Neuro examine the application of new advances in brain imaging, such as MRI morphometry, computational modeling and diffusion tensor imaging. By revealing lesions that were previously undetected by visual assessments, quantitative structural MRI methods such as these have clearly demonstrated a significantly improved rate of diagnosis of lesions, and have provided successful surgical options to an increasing number of patients with cryptogenic epilepsy.
Electrical brain patterns reveal development and progression of epilepsy:
Epileptogenesis refers both to how a normal brain becomes epileptic in the first place and to how a mildly epileptic brain can worsen. Scientists are finding important clues as to what is happening at each stage of the epileptogenic process. Their findings could lead to avenues for preventing the onset of epilepsy, or at least to stop it from progressing. Recordings of electrical activity in the brain of epileptic patients reveal high-frequency oscillations (HFOs 80-600Hz). These are very hard to detect and thought to reflect pathological activity and seizure onset zones. In a new study published in Neurolobiology of Disease, researchers at The Neuro have identified types of electrical brain activity that correlate with seizure activity. Distinct patterns of electrical brain activity point at dynamic processes that bring nerve cell networks close to seizure generation and reflect distinct pathological neuronal states underlying epileptogenesis. These patterns could be used to predict high susceptibility to seizures, and to identify periods of increased seizure occurrence. In a separate Neuro study published in the Annals of Neurology, it was found that removing HFO-generating brain areas improved the outcome of surgical treatments for epilepsy.
Facts about Epilepsy:
- Epilepsy is a physical condition characterized by sudden, brief changes in how the brain works. It is a symptom of a neurological disorder - that affects the brain and shows itself in the form of seizures
- Approximately 1-2% of the Canadian population has epilepsy. This includes people who take anticonvulsant drugs or who have had a seizure within the past 5 years.
- Each day in Canada, an average of 42 people learn that they have epilepsy.
- A seizure may appear as a brief stare, an unusual movement of the body, a change in awareness, or a convulsion. A seizure may last a few seconds or a few minutes.
- Epilepsy may result from a variety of causes. These include:
· Malformations of brain development
· Head injury that causes scarring to the brain tissue
· High fever and prolonged convulsions during early childhood
· Trauma at birth
· The result of a stroke or tumor
- In almost one third of patients, seizures cannot be controlled despite the best possible medications.
In these patients, surgical resection of the brain area causing seizures is presently the only effective treatment in controlling seizures and improving quality of life.
The Neuro and Epilepsy:
· The Neuro has been at the forefront of epilepsy treatment and research for three quarters of a century.
· Dr. Wilder Penfield and his team developed the “Montreal Procedure,” a surgical approach that explores the brains of epilepsy patients while they are awake and under local anesthetic in order to find the precise tissue causing the seizures and to minimize the risks of surgery.
· Scientists and clinicians at The Neuro pioneered the use of EEG to measure brain activity, and have developed new ways to diagnose and control epilepsy.
· Today, scientists at The Neuro study the genetic factors of epilepsy and epileptic syndromes, use EEG to monitor the electrical manifestations of epileptic seizures, and also treat the psychiatric aspects of epilepsy.
· Brain imaging techniques developed at The Neuro have greatly contributed to the understanding of causes and consequences of epilepsy. Importantly, they have facilitated epilepsy surgery by unveiling brain lesions that are not seen by standard radiological methods.
· The Neuro’s Epilepsy Clinic sees about 1500 patients per year and provides both in-patient and out-patient evaluation and treatments.
· The Neuro’s Epilepsy Program has a multi-disciplinary team that includes epileptologists, neurosurgeons, nurses, neuropsychologists, neuropsychiatrists, social workers, EEG technologists, nurse clinicians and case managers.
· The Epilepsy team works closely with our community partner Epilepsy Montreal Metropolitain in providing monthly support group meetings at The Neuro.
About the Montreal Neurological Institute and Hospital: The Montreal Neurological Institute and Hospital -The Neuro- is a unique academic medical centre dedicated to neuroscience. The Neuro is a research and teaching institute of McGill University and forms the basis for the Neuroscience Mission of the McGill University Health Centre. Founded in 1934 by the renowned Dr. Wilder Penfield, The Neuro is recognized internationally for integrating research, compassionate patient care and advanced training, all key to advances in science and medicine. Neuro researchers are world leaders in cellular and molecular neuroscience, brain imaging, cognitive neuroscience and the study and treatment of epilepsy, multiple sclerosis and neuromuscular disorders. For more information, please visit www.mni.mcgill.ca.