Many epilepsy patients are afraid of surgery zurück. However, improved imaging, and modern surgical procedures köcan Affected for seizure freedom help
In front of a möaligned Operation to be studied, the patients of Professor Hajo Hamer by means of EEG
A lot more people with epilepsy than in the past ködestroyed by a Operation benefit. This conclusion lässt a große international study, only a few months ago in the prestigious journal the New England Journal of Medicine veröwas released. Here, researchers evaluated the data of almost 10 000 patients who had undergone due to insufficient effect of drugs surgery.
The result: 58 per cent of the affected adults were after the procedure, completely free of seizures, in children the success rate was even slightly hö. Für Epileptologen is the more reason the Möurgent not to lose a surgical procedure of the eyes, if drugs help the patient.
If the drugs don’t work, can help a Operation
"Schäup way, there are about ten percent of surgery benefit könnten", Professor Hajo Hamer, Director of the epilepsy center at the Universitä says;clinic Erlong. He says, if two drugs are sufficient to Anfäto prevent lle, should allow a Patient to at least investigate whether an intervention, in principle, für. .
The wüProfessor Felix ­ want to get up;Rosenow, head of the epilepsy center at the University hospital in Frankfurt. Currently wüauthorities per year in Germany, only 500 operations in this so-called drug-resistant epilepsy durchgeführt. A very small proportion, considering the total number of patients in Germany: according to information from the German epilepsy Association around 500 000 Affected in ämedical treatment.
The consequences of epilepsy are often unterschätzt
Expertenschärequirements according to kötens of thousands of humans by surgery permanently seizure-free. And this is according to experts, is an important goal, because epileptic Anfäll be häoften unterschätzt. Risky especially generalized Anfä are;lle, the right pulse thunderstorms throughout the brain auslösen, and in addition to Krampfanfäcases also cause loss of consciousness.
The consequences of köcan be dramatic. Schärequirements according to jä die in Germany;every year between 600 and 1000 patients of the consequences of an epileptic seizure. The uncontrolled nerve signals köcan, for example, Herzrhythmusstöbrackets cause or the respiratory regulation beeinträmighty.
The epilepsy is already well treatable. Alone by drugs, two thirds of the patients are permanently seizure-free. "You are still the main pillars of the Therapie", Hamer says. The modern drugs have improved the treatment significantly in recent years. "These drugs do not seem to be better, but they are much more verträglicher", resümiert the Erlanger expert.
Help through a drug from the Cannabis Plant?
And the development of new drugs lärunning at full speed. Several drugs are currently being clinically geprüft. To zämiss plant, among others, substances from the cannabis. However, experts are skeptical: "There are currently a lot of fuss about everything Cannabis in the name of trägt", Professor Heidrun Potschka, Pharmacologist, Ludwig-Maximilians-Universitä says;t MüMunich.
Especially the psycho-active substances in the Cannabispflanze such as, for example, the Tetrahydrocannabinol (THC) köcould probably even Anfälle auslösen and womöthe Gehirn­ possible;development of young people in a negative affect, so the Pharmacologist.
Otherwise it is acting in the ingredient Cannabidiol, which have a different mechanism of action. In the first studies of severe genetic forms of epilepsy in children could Cannabidiol tatsäthe take a effect. Currently running außerdem studies for the treatment of other forms of Epilepsy. "The Trend is for the development of specific therapies füindividual Epilepsieformen", weiß Potschka.
Long time to diagnosis and treatment of a Epilepsie
In spite of good therapeutic Möopportunities it takes many Fäcases, often years before the disease is diagnosed. And also patients who do not respond to medication, surgery, on average, only 16 years after the first attack. In the meantime, a lot can happen: Due to the Anfäll lose a number of epilepsy patients your Füdriving license, the Job, and sometimes the circle of friends.
Nevertheless, many Sufferers fear the way in one of the epilepsy facilities that exist nationwide in many hospitals and centres of expertise, and zöthe step to a stationären diagnosis, – especially for the Operation. Often be Älongest before the surgery on the brain, says expert Hajo Hamer. Rather, they bear the Anfälle. "Many do not know that there are more Möopportunities are, or you are simply in the Situation gewöhnt", ergänzt the Frankfurt epilepto Lodge Rosenow.
Progress through improved imaging
The Äthe youngest of the patients are real – even if the Ädoctors affirm that the diagnostic and operational Mövenues have become in the past few years. "We köcan us today to complex Fälle wagen", emphasizes Hamer. Especially, the imaging had improved significantly.
"Modern Magnetresonanz techniques to take a lot more layers than ügenerally, Spezialsequences ermöaligned with a more detailed view of the Gehirn", erklärt Felix Rosenow. So Epileptologen often recognize on the MRI image small Verächanges, the für the Anfäll be responsible köcan.
To the practicing neurologist in remote regions at the time of diagnosis to unterstüsupport, works Rosenow at a Fördergeldern Hessian ministries unterstüestimated telemedicine project: The attending physician sends Patient data and MRI images to the specialists at the Frankfurt University hospital. Via video conference, the physicians exchange anschließend with each other and develop a schlüone story treatment concept für the Affected.
Before surgery, the Patient is examined carefully
Endgüare to be found clarity as to whether an Operation für the patient tatsäactually out of the question, but can ultimately create a study in an epilepsy center. There he is für a Elektroenzephalogramm (EEG) cables – a plurality of electrodes on the head to take the nerve signals from the brain and send them by radio to the Headquarters.
So ausgerüstet, waiting for the doctors to have an epileptic seizure. Zusäin addition to the Patient around the clock by ­ is;Video camera ümonitored. In the next room, the images flicker über monitors: Füthe doctor ­ can;every movement, every expression of the face and the eyes wäduring a seizure is important information darüber supply, in which Region of the brain the epilepsy begins. This is the prerequisite für a mödaily chigical therapy.
A seizure causing, müshot some Patients für the duration of the stay to settle their epilepsy medication. The EEG data, because the Auflösung to weak kö, ;the electrodes can also be in a surgery für the duration of the investigation, the Schädelceiling to be implanted. "Such depth electrodes are today häsingle-stage eingesetzt", erklärt expert, Hamer. A neurophysiological investigation schließwhether an intervention spiritual or köphysical Fäskills verächange würde. So the doctors are trying to reduce the risk of intervention to a Minimum.
Surgical procedures for epilepsy
Resection
In most Fäcases removed the Neurochirurg the erroneous Gehirnareas, of which the epilepsy-out signals. "Often the weak are cal Verächanges in the Temporallappen", erklärt Professor Hartmut Vatter, a neurosurgeon at the University hospital Bonn.
To öopened by the surgeon under General anesthesia, the Schädeldecke in Schläfenbereich, navigated with a special instrument to the area of the epilepto Lodge as the stove has identified and removed the faulty tissue with ultrasonic, micro-cups or a current passes through the tweezers.
By separation
"You have identified the Area, it is not necessary to herausschneiden" it always necessarily;, Vatter says. Sometimes genüge, the nervous connections to the Rest of the brain to durchdisconnect. This was not, however, in all Fäcases möpossible.
Deep Brain Stimulation
Stimulation methods pursue a different goal: Using electrodes to electrical impulses, the Aktivität of nerve cells in the brain affect. In the case of deep brain stimulation of the neuro-surgeon implanted a Stimulator under the Schlüsselbein. The electrodes it uses in deep areas of the brain, the Thalamus. In contrast to the resection köcan Anfälle in most patients, but not, but, at best, reduced can be prevented.
Vagusstimulator
The Einschrälimitation also applies für the nerve-vagus-Stimulation. The electrode is mounted in the neck at the vagus nerve. This nerve connects the brain stem with zahlrich internal organs.
Doctors suspect that the pacemaker impulses inhibiting nerve cells activate. "The vagus nerve Stimulation is suitable for use when no stove can be found, or if the Patient is in surgery and not at the brain mö be;chte", so Vatter.
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