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Ask Stanford Med: Neurologist taking questions on drug-resistant epilepsy

Epilepsy affects about one in 100 people across the globe. The brain is, in essence, a complicated electrochemical calculating machine, containing a huge number of circuits that process information and share it with other, often-remote circuits. The resulting networks can be of sometimes staggering complexity. Epileptic seizures are, at root, electrical storms triggered when a short-circuit at one tiny spot within the brain, called the focus, causes waves of electrical activity to spread throughout a specific network. The focus’s exact location varies from patient to patient, and the network affected also varies. That is why seizures can be different in type.

Seizures can usually be controlled with medication. But when they can’t, patients are prone to repeated seizures that can seriously impair their ability to lead normal lives. Fortunately, says neurologist Josef Parvizi, MD, PhD, director of the Stanford Program for Drug-Resistant Epilepsies, a surgical procedure can be tremendously effective, as long as the surgery itself does not cause any loss of brain function.

In this procedure, a portion of the patient’s skull is temporarily removed, allowing access to the brain’s surface near the spot thought to be responsible for initiating the seizures. A thin plastic film containing numerous electrode leads is placed next to the brain, with each electrode separately monitoring electrical activity there. (The procedure doesn’t destroy tissue or disrupt brain function.) The patient remains off medication, bedridden but fully conscious and pain-free, for up to a week. The resulting onset of repeated seizure activity lets the neurological team identify the focus of the patient’s seizures. It also allows the team to map the function of the brain areas that are being considered for resection and ensure that the surgery will be safe. Surgeons may then be able to remove just enough brain tissue at that position to halt the cycle of self-propagating electrical activity, like pulling out a fuse to break a short circuit, without affecting any important brain functions.

For our latest installment of Ask Stanford Med, we've asked Parvizi to answer questions regarding drug-resistant epilepsy and this procedure. You can submit a question by either sending a tweet that includes the hashtag #AskSUMed or posting it in the comments section below. We’ll collect questions until Wednesday (June 19) at 5 PM Pacific Time.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses

Parvizi will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Positive results in deep-brain stimulation trial for epilepsy and Brain implant designed for patients with difficult-to-treat epilepsy

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