About epilepsy and multiple subpial transection (mst)

What is epilepsy and multiple subpial transection (mst)?

Sometimes brain seizures begin in a vital area of the brain -- for example, in areas that control movement, feeling, language, or memory. When this is the case, a relatively new epilepsy treatment called multiple subpial transection (MST) may be an option. MST stops the seizure impulses by cutting nerve fibers in the outer layers of the brain (gray matter), sparing the vital functions concentrated in the deeper layers of brain tissue (white matter).

Who Is a Candidate for Multiple Subpial Transection?

Most people with epilepsy can control their seizures with medication. However, about 20% of people with epilepsy do not improve with drugs. In some cases, surgery to remove the part of the brain causing the seizures may be recommended.

MST may be an option for people who do not respond to medication and whose seizures begin in areas of the brain that cannot be safely removed. In addition, there must be a reasonable chance that the person will benefit from surgery. MST may be done alone or with the removal of a section of brain tissue (resection). MST also may be used as a treatment for children with Landau-Kleffner syndrome (LKS), a rare childhood brain disorder which causes seizures and affects the parts of the brain that control speech and comprehension.

What Happens Before Multiple Subpial Transection?

Candidates for MST undergo an extensive pre-surgery evaluation -- including seizure monitoring, electroencephalography (EEG), magnetic resonance imaging (MRI), and positron emission tomography (PET). These tests help to pinpoint the area in the brain where the seizures occur and determine if surgery is feasible.

Another test to assess electrical activity in the brain is EEG-video monitoring, in which video cameras are used to record seizures as they occur, while the EEG monitors the brain's activity. In some cases, invasive monitoring -- in which electrodes are placed inside the skull over a specific area of the brain -- is also used to further identify the tissue responsible for seizures.

© 2005-2015 WebMD, LLC. All rights reserved.
Source article on WebMD

What Happens During Multiple Subpial Transection?

MST requires exposing an area of the brain using a procedure called a craniotomy. ("Crani" refers to the skull and "otomy" means "to cut into.") After the patient is put to sleep with anesthesia, the surgeon makes an incision (cut) in the scalp, removes a piece of bone and pulls back a section of the dura, the tough membrane that covers the brain. This creates a "window" in which the surgeon inserts his or her surgical instruments. The surgeon utilizes information gathered during pre-surgical brain imaging to help identify the area of abnormal brain tissue and avoid areas of the brain responsible for vital functions.

Using a surgical microscope to produce a magnified view of the brain, the surgeon makes a series of parallel, shallow cuts (transections) in gray matter, just below the pia mater (subpial), the delicate membrane that surrounds the brain (it lies beneath the dura). The cuts are made over the entire area identified as the source of the seizures. After the transactions are made, the dura and bone are fixed back into place, and the scalp is closed using stitches or staples.

What Happens After Multiple Subpial Transection?

After MST, the patient generally stays in an intensive care unit for 24 to 48 hours and in a regular hospital room for three to four days. Most people who have MST will be able to return to their normal activities, including work or school, in six to eight weeks after surgery. Most patients will continue to take anti-seizure medication. Once seizure control is established, medications may be reduced or eliminated.

How Effective Is Multiple Subpial Transection?

MST results in satisfactory improvement in seizure control in about 70% of patients, although the procedure is still relatively new, and no long-term outcome data are available. Children with LKS or other forms of epilepsy not controlled by medication may have improved intellectual and psychosocial functioning following MST.

What Are the Side Effects of Multiple Subpial Transection?

The following side effects may occur after MST, although they generally go away on their own over several weeks:

  • Scalp numbness.
  • Nausea.
  • Feeling tired or depressed.
  • Headaches.
  • Difficulty speaking, remembering, or finding words.

What Happens During Multiple Subpial Transection?

MST requires exposing an area of the brain using a procedure called a craniotomy. ("Crani" refers to the skull and "otomy" means "to cut into.") After the patient is put to sleep with anesthesia, the surgeon makes an incision (cut) in the scalp, removes a piece of bone and pulls back a section of the dura, the tough membrane that covers the brain. This creates a "window" in which the surgeon inserts his or her surgical instruments. The surgeon utilizes information gathered during pre-surgical brain imaging to help identify the area of abnormal brain tissue and avoid areas of the brain responsible for vital functions.

Using a surgical microscope to produce a magnified view of the brain, the surgeon makes a series of parallel, shallow cuts (transections) in gray matter, just below the pia mater (subpial), the delicate membrane that surrounds the brain (it lies beneath the dura). The cuts are made over the entire area identified as the source of the seizures. After the transactions are made, the dura and bone are fixed back into place, and the scalp is closed using stitches or staples.

What Happens After Multiple Subpial Transection?

After MST, the patient generally stays in an intensive care unit for 24 to 48 hours and in a regular hospital room for three to four days. Most people who have MST will be able to return to their normal activities, including work or school, in six to eight weeks after surgery. Most patients will continue to take anti-seizure medication. Once seizure control is established, medications may be reduced or eliminated.

What are the symptoms for epilepsy and multiple subpial transection (mst)?

Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing Seizures or periods of unusual behavior, sensations and sometimes loss of awareness

Anyone can develop epilepsy. Epilepsy and multiple subpial transection (MST) affects both males and females of all races, ethnic backgrounds and ages
Because epilepsy is caused by abnormal activity in the brain, Seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:
1. Temporary Confusion
2. A staring spell
3. Stiff muscles
4. Uncontrollable jerking movements of the arms and legs
5. Loss of consciousness or awareness
6. Psychological symptoms such as fear, Anxiety or deja vu
7. Doctors generally classify Seizures as either focal or generalized, based on how and where the abnormal brain activity begins.
8. Focal seizures: When Seizures appear to result from abnormal activity in just one area of your brain, they're called focal seizures. These Seizures fall into two categories:
9. Focal Seizures without loss of consciousness
10. Focal Seizures with impaired awareness.
11. Generalized seizures: Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized Seizures exist.
12. Absence seizures: Typically occur in children. They're characterized by staring into space with or without subtle body movements such as eye blinking or lip smacking and only last between 5-10 seconds.
13. Tonic seizures. Tonic Seizures cause stiff muscles and may affect consciousness.
14. Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control.
15. Clonic seizures.
16. Myoclonic seizures.
17. Tonic-clonic Seizures

Symptoms
Temporary Confusion A staring spell,Stiff muscles,Uncontrollable jerking movements of the arms and legs
Conditions
Focal Seizures and generalised Seizures
Drugs
Anti-epileptic (anticonvulsant, antiseizure) drugs,Vagus nerve stimulator. T,Brain surgery

What are the causes for epilepsy and multiple subpial transection (mst)?

Epilepsy is a central nervous system disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations and sometimes loss of awareness. Every year, there are about 180,000 new instances of epilepsy. 30% of cases include youngsters. The most frequently impacted groups are young people and senior citizens.

Only a small percentage of cases of Epilepsy and multiple subpial transection (MST) have a known cause. The recognised causes of seizures frequently entail brain damage. The following are some of the main causes of epilepsy:

1. Family background.
2. Up to 40% of all epilepsy cases are caused by a person's genetic composition, which increases their risk of developing the condition.
3. Epilepsy is caused by multiple genes, not just one. In fact, according to some experts, there might be 500.
4. You have a larger probability of developing epilepsy than someone who doesn't if your parent or sibling has it.
5. Although doctors are unsure of how it is handed on, they speculate that it may be linked to a gene mutation that affects the nerve cells in the brain.
6. Having this mutation does not guarantee that you will get epilepsy.
7. The mix of genetics and another factor, such as a medical condition, may be to blame, according to experts.
8. Injury sustained prior to, during, or shortly after birth.
9. Epilepsy risk increases with any issues with brain development in the womb or during the first few months of life.
10. Babies in the womb may suffer from brain injury for a variety of reasons, including the mother's infection, unsound nutrition and inadequate oxygen.

Symptoms
Temporary confusion A staring spell,Stiff muscles,Uncontrollable jerking movements of the arms and legs
Conditions
Focal seizures and generalized seizures
Drugs
Anti-epileptic (anticonvulsant, antiseizure) drugs,Vagus nerve stimulator. T,Brain surgery

What are the treatments for epilepsy and multiple subpial transection (mst)?

Epilepsy and Multiple subpial transection (MST) is a technique used to disconnect areas of the brain where seizure activity occurs. The goal of the surgery is to stop the spread of irregular electrical activity that causes seizures.
The procedure may be recommended when the area of epileptic activity in the brain is not able to be resected and does not respond to medication.
The surgery aims to destroy fibers that transfer the epileptic electrical activity while protecting other fibers that provide critical functions such as language and motor skills.
A child may be a candidate for MST if they are experiencing partial seizures that do not respond to medication and are originating in an area of the brain that is not resectable due to the location of the lesion.
PROCEDURE
1. The child will be placed under general anesthesia in a pre-operation room. Then they will be taken into the operating room and a small section of hair will be shaved from their head.
2. Surgeons will then make an incision and perform a craniotomy, where a small portion of the skull is removed. Next, the surgeons will access the cerebral cortex and make multiple small incisions on the surface of the brain.
3. These incisions will interrupt the abnormal electrical activity, preventing the ability for it to spread and cause seizures. After the operating team will close the incision and your child will be admitted to the pediatric intensive care unit (PICU). The patient will typically spend one night in the PICU and two to three nights in a regular hospital room before returning home.

Symptoms
Temporary confusion A staring spell,Stiff muscles,Uncontrollable jerking movements of the arms and legs
Conditions
Focal seizures and generalized seizures
Drugs
Anti-epileptic (anticonvulsant, antiseizure) drugs,Vagus nerve stimulator. T,Brain surgery

What are the risk factors for epilepsy and multiple subpial transection (mst)?

The risks associated with MST include:

  • Risks associated with surgery, including infection, bleeding, and an allergic reaction to anesthesia
  • Failure to relieve seizures
  • Swelling in the brain
  • Damage to healthy brain tissue

Is there a cure/medications for epilepsy and multiple subpial transection (mst)?

Epilepsy and Multiple subpial transection (MST) treatment options include:
1. Anti-epileptic (anticonvulsant, antiseizure) drugs: Anti-epileptic medications can help reduce the number of seizures you have. In some people, they may eliminate seizures. To be most effective, the medication must be taken exactly as your doctor prescribed.
2. Vagus nerve stimulator: This device is surgically placed under the skin on your chest and electrically stimulates the nerve that runs through your neck to prevent seizures.
3. Brain surgery: The area of the brain that causes seizure activity can be removed or altered if you and your healthcare team determine it’s the right treatment for your condition.
Minimally invasive surgeries and radiosurgery are also being investigated.

Medications for epilepsy
1. The first-line treatment for epilepsy is antiseizure medication. These drugs are designed to help reduce the frequency and severity of seizures. They cannot stop a seizure that’s already in progress, and they are not a cure for epilepsy.
2. These medications are absorbed by your stomach. They then travel through your bloodstream to your brain. They affect neurotransmitters in a way that reduces the electrical activity that leads to seizures.
3. There are many antiseizure drugs on the market. Your doctor can prescribe a single drug or a combination of drugs, depending on your type of seizure.
Common epilepsy medications include:
1. Levetiracetam (Keppra)
2. Lamotrigine (Lamictal)
3. Topiramate (Topamax)
4. Valproic acid (Depakote)
5. Carbamazepine (Tegretol)
6. Ethosuximide (Zarontin)

Symptoms
Temporary confusion A staring spell,Stiff muscles,Uncontrollable jerking movements of the arms and legs
Conditions
Focal seizures and generalized seizures
Drugs
Anti-epileptic (anticonvulsant, antiseizure) drugs,Vagus nerve stimulator. T,Brain surgery

Video related to epilepsy and multiple subpial transection (mst)