An innovative surgical technique gives hope to patients suffering from refractory epilepsy



    One of the patients will also be available for interviews
    ---------------------------------------------------------

    MONTREAL, June 10 /CNW Telbec/ - Clinicians from the Centre hospitalier
de l'Université de Montréal (CHUM) have perfected an operation, which was
previously considered too dangerous, to control refractory insular epilepsy,
using an innovative microsurgery technique. According to a study published as
the feature article in the latest issue of the Journal of Neurosurgery, the
new surgical technique is both safe and beneficial for patients.
    "Recent observations by our team and others confirm the previously
unsuspected role played by the insula in cases of refractory epilepsy. The
non-recognition of insular seizures has probably been responsible for some
failures in epilepsy surgery in the past," note doctors Alain Bouthillier,
neurosurgeon, and Dang Khoa Nguyen, neurologist, the study's principal
investigators, who teach at Université de Montréal and are researchers at the
CHUM's research centre.
    For many years, insular surgery to treat refractory epilepsy was
abandoned and it is still rarely practiced because of the risk of damaging
important structures of the brain. Initial attempts to resect the insula
resulted in a high rate of complications, including hemiparesis (partial
paralysis) and dysphasia (language loss). However, better understanding of the
anatomy of the brain, in particular, the cerebral cortex and its vascular
system, combined with the use of microsurgical techniques, now enable surgery
to be performed on the insula, with greatly reduced risk to the patient. "This
is the first cohort of patients with refractory epilepsy to have undergone
such a procedure since the work of neurosurgeon Wilder Penfield in the 1950s,
"adds one of the investigators, Dr. Ramez Malak, neurosurgical resident.

    Methodology

    A retrospective study over the past ten years evaluated cases of patients
with refractory epilepsy who had undergone insular surgery. In order to
confirm the epileptic foci, intracranial electrodes were implanted, with the
surgeon using neuronavigation and magnetic resonance imaging of the brain.
Insulectomy was performed either

    
    -  as part of an insulooperculectomy, in which the insula and the
       opercula (meaning "lids": the lips of the deep fold that separates the
       frontal, temporal and parietal lobes) are completely removed;
    -  by resection of the temporal lobe with insulectomy;
    -  or as a pure insulectomy.
    

    Results

    Nine patients were treated successfully with insular surgery, seven for
refractory epilepsy without tumour and two with refractory epilepsy associated
with the presence of tumours. After surgery, some patients presented with
transient complications (hemiparesis, dysphasia), which disappeared after a
few days or weeks post-surgery.
    One patient, who had suffered from regular epileptic seizures, despite
numerous essays with a variety of anticonvulsants, has had no seizures since
surgery and no complications. She was also able to stop taking
anticonvulsants.

    The role of the insula

    The insula is one of the lobes of the brain. Its role is still not well
understood but its multiple connections with other parts of the brain reflect
its involvement in a wide range of functions: automatic, sensory, motor,
speech, auditory, olfactory, gustatory and limbic (emotion).

    The CHUM epilepsy multidisciplinary team

    The epilepsy multidisciplinary team is one of the principal groups of
clinicians and professionals in Quebec treating people suffering from
epilepsy. This unit is a centre of excellence, where services to its clientele
and fundamental and clinical research and teaching activities are
concentrated. Providing tertiary and quaternary services, the members of the
CHUM epilepsy multidisciplinary team work in conjunction with partners in the
health network to provide their patients with continuity of care.

    Link to the study : http://thejns.org/doi/pdf/10.3171/2009.1.JNS08807

    For images and photos : please contact the CHUM.

    About the CHUM : www.chumontreal.qc.ca




For further information:

For further information: Nathalie Forgue, Communications Advisor, CHUM,
(514) 890-8000, extension 14342, Pager: (514) 801-5762; Source: Centre
hospitalier de l'Université de Montréal, Neurosurgery and Neurology services
and Communications Division

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Centre hospitalier de l'Université de Montréal (CHUM)

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