IUBio

pathology of epilepsy

F. Frank LeFever flefever at ix.netcom.com
Thu Sep 17 23:12:45 EST 1998


Re Jeff's attempt at an answer...

Well....Where to begin?  "Crossing the synapse ineffectively"?  Well,
no; one might say TOO effectively--or more to the point, there is an
imbalance between excitatory synapses (e.g. NMDA glutaminergic) and
inhibitory ones (e.g. GABA).  Crudely, think of a runaway engine with
no governor, no brakes, etc.

There is a long list of drugs one tries, and dosages, monitored by
blood levels and by efficacy before one gives up on drug treatment and
tries others. 

It is a bit misleading to cite vagal stimulation among surgical
procedures--the surgery is quite minor.  What one avoids until there is
no other recourse is the MAJOR surgery of having a large portion of one
of the temporal lobes removed (not the only but the most common
resection). One chooses which lobe (left or right) based on data from
brain imaging (e.g. MRI, SPECT), EEG, and neuropsychological testing
(including testing with amytal numbing of one hemisphere at a time, the
Wada test).

 (n.b.: never BOTH temporal lobes; not since the famous case of the
unfortunate patient HM)

re tumors: yes, one can SOMETIMES have seizures triggered by a tumor,
as well as by alcohol withdrawal, high fevers (especially infantile)
and a few other things, but these are not typical etiologies of
EPILEPSY.  In some cases, cortical scarring can be identified
(sclerosis) but in others no obvious damage can be seen at the
epileptogenic focus (from whence the seizure activity spreads);
presumably there is a subtle neurochemical fault (cf. my point re
excitatory amino acids etc. and inhibitory influences).

Another treatment for intractable or treatment resistant epilepsy: the
ketogenic diet--i.e., protein, much fat, and no carbohydrates.

QUERY FOR THOSE OUT THERE WITH EXPERIENCE OR INFO ABOUT KETOGENIC DIET:
It is my understanding that this is normally undertaken with children;
does anyone have long-term follow-up data re general health
consequences?  e.g. cholesterol levels, cardiovascular consequences,
etc. ?  This question has implications beyond epiulepsy, considering
the recurrent popularity of the so-called Atkins diet for overweight
adults...

F. Frank LeFever, Ph.D.
New York Neuropsychology Group


In <Pine.GSO.3.95.980916105223.18958A-100000 at mail4.wayne.edu>
<ad7777 at wayne.edu> writes: 
>
>On Sun, 13 Sep 1998, Virendra Mittal wrote:
>
>> can someone please tell me what is the pathology of epilepsy
>> 
>>Epilepsy can be casued by several different factors.  Essentially
signals
>are crossing the synapse ineffictivley.  The may be secondary to a
>pathologic condition of the brain such as a tumor or it may cave come
from
>trauma to the brain itself.  
>
>There are several treatments available to people with epilepsy.  The
first
>being the most non-invasive is medication such as Tegretol and
Dilantin.
>The next step after that is surgery,  a new advance in epilepsy
surgery is
>out there now,  It is called a Vagus Nerve Stimulator.  It works by
>sending eletrical implulses to the brain via the vagus nerve that runs
>along in the neck.  You can learn more about this excellent treament
by
>visiting:  www.cyberonics.com.
>
>Hope this helped you:
>
>Jeff
>
>cortese at neurosurg.wayne.edu > > 
>




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