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Functional Imaging in Movement Disorders

Acknowledgments This work was supported by grants from NIH (NS075321, NS41509, NS103957, NS075527, NCATS U54TR001456 & Office of Rare Disease Research), American Academy of Neurology & American Brain Foundation Clinical Research Training Fellowship, the Barnes Jewish Hospital Foundation (Elliot Stein Family Fund and Parkinson Disease Research Fund), the Dystonia Medical Research Foundation, the American Parkinson Disease Association Advanced Research Center at Washington University, the Oertli Fund…

Patient Selection Criteria for Deep Brain Stimulation in Movement Disorders

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 106.1 . Key Concepts The most important determinant for obtaining the best outcomes after deep brain stimulation (DBS) surgery is careful patient selection. The US Food and Drug Administration–approved indications for DBS include Parkinson disease (PD), essential tremor (ET), and primary dystonia. DBS should only be considered for patients with confirmed…

Clinical Overview of Movement Disorders

Acknowledgments We would like to acknowledge the support of the National Parkinson Foundation via a Center of Excellence award, the McKnight Brain Institute (Gainesville, FL), the University of Florida, Shands Hospital (Gainesville, FL), and the Eric and Jennifer Scott Fund for Parkinson’s Research (Gainesville, FL). Drs. Mustafa Siddiqui and Jessica Tate (Wake Forest School of Medicine) contributed significantly to this chapter in prior editions. This chapter…

Neuropathology of Movement Disorders

This chapter includes an accompanying slide presentation that has been prepared by the author: Video 104.1 . Key Concepts Movement disorders include hypokinetic-rigid and hyperkinetic or mixed forms mainly originating from dysfunction of the basal ganglia. Disruption of the essential cortico–basal ganglia–thalamocortical and basal ganglia–brainstem-cerebellar connections are related to these disorders. Major movement disorders concern parkinsonism, chorea, myoclonic syndromes, tremor syndromes, ballism, dystonias, and tics. Most…

Rationale for Surgical Interventions in Movement Disorders

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 103.1 . Key Concepts The basal ganglia, thalamus, and cortex are arranged in topographically organized circuits that remain segregated throughout their cortical-subcortical course. These circuits subserve different functions (e.g., motor, limbic, associative). Many movement disorders involve motor circuit dysfunction that can be addressed by surgical interventions that target the specific motor…

Anatomy and Synaptic Connectivity of the Basal Ganglia

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 102.1 . Key Concepts The basal ganglia are a group of interconnected subcortical structures that comprise the dorsal striatum (caudate nucleus and putamen); the ventral striatum (nucleus accumbens); the external and internal segments of the globus pallidus (GPe and GPi, respectively); the subthalamic nucleus (STN); the substantia nigra, which includes the…

Epilepsy Surgery: Outcomes and Complications

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 101.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 101.1 . Key Concepts Resective epilepsy surgery is an effective treatment for drug-resistant focal epilepsy, with demonstrated long-term rates of seizure freedom of at least 50% a decade after surgery. Seizure outcomes at 1…

Electrical Stimulation for Epilepsy (VNS, DBS, and RNS)

Disclosure Dr. Gross serves as a consultant to Medtronic and NeuroPace, Inc., and receives compensation for these services. Medtronic and NeuroPace develop products related to the research described in this chapter. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict of interest policies. This chapter includes an accompanying lecture presentation that has been prepared by the authors:…

Hemispheric Disconnection Procedures

Key Concepts The indication for hemispheric deafferentation is severe hemispheric damage causing drug-resistant epilepsy. In the past, anatomic hemispherectomy was replaced by functional hemispherectomy. Functional hemispherectomy has been replaced largely by hemispherotomy. Hemispherotomy is a disconnection of the cortical mantle from the basal ganglia bloc. In hemispherotomy, resection of brain tissue has been largely replaced by disconnection. Three common techniques available for hemispheric disconnection are disconnection…

Laser Interstitial Thermal Therapy in Epilepsy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 98.1 . Key Concepts MRgLITT is a rapidly evolving technology that is being applied for an increasing number of types of focal epilepsy. The most common application of MRgLITT in epilepsy continues to be in mesial temporal lobe epilepsy (MTLE). MRgLITT has also been used in conditions such as focal cortical…

Radiosurgical Treatment for Epilepsy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 97.1 . Key Concepts Minimizing the invasiveness and rate of complications is very crucial in management of already severely disabled epileptic patients. Low rates of surgical complications and neurological consequences after radiosurgery are the main advantages over open surgery techniques. Radiosurgery is currently being evaluated as an alternative (or adjunct) treatment…

Palliative Procedures for Drug-Resistant Epilepsy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 96.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 96.1 . Key Concepts There is a subset of patients with refractory epilepsy in whom palliative interventions are indicated. Palliative surgical procedures for epilepsy are not curative, but they lessen disease burden and can…

Resections for Extratemporal Epilepsy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 95.1 . Key Concepts Describe the basic semiology of seizures arising from the frontal, parietal, and occipital lobes, as well as the insula and perisylvian and perirolandic regions. Describe methods available to localize seizures in the aforementioned areas, including both invasive and noninvasive methods. Discuss basic surgical technique associated with resection…

Selective Amygdalohippocampectomy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 94B.1 . Key Concepts The selective amygdalohippocampectomy (SAH) appears to be as effective in terms of seizure outcomes as a traditional anterior temporal lobectomy (ATL) in patients with mesial temporal epilepsy. The subtemporal selective approach removes the mesial temporal structures without disrupting the anterolateral temporal lobe or the temporal stem. Selective…

Anteromedial Temporal Lobectomy

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 94A.1 . Key Concepts Anteromedial resection is a safe and effective approach for medial temporal lobe epilepsy (MTLE). Preoperative work-up guides the resection. Anatomic landmarks are the foundation of a successful operation. Patient positioning is important. Knowledge of postoperative deficits is important to address during the discussion preceding consent. Historical Perspective…

Investigation of Human Cognition in Epilepsy Surgery Patients

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 93.1 . Key Concepts A number of research approaches appropriate for a neuroscientific investigation of cognition are afforded in human epilepsy surgical patients. The most common is intracranial electroencephalography (iEEG), a powerful neuroscientific tool that represents a bridge between noninvasive human functional imaging and invasive single neuron recordings in nonhuman animals.…

Intraoperative Mapping and Monitoring for Cortical Resection

This chapter includes an accompanying lecture presentation that has been prepared by the authors, along with Dr. Nitin Tandon: Video 92.1 . Key Concepts Preoperative counseling is important for successful intraoperative mapping. Thorough evaluation of patients with lesions in eloquent cortex may involve functional neuroimaging. Intraoperative cortical mapping is the “gold standard” for delineating the functional areas of cortex. Patients benefit from proper counseling and rehearsal…

Intraoperative Electrocorticography and Strategy in Tailored Lesionectomies

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 91.1 . Key Concepts Topectomy/lesionectomy is an excellent procedure for the treatment of drug-resistant focal epilepsy when the epileptogenic focus can be isolated Intraoperative electrocorticography (ECoG) provides real-time feedback to improve maximal safe epileptogenic focus resection Preoperative planning with anesthetic considerations is critical to ensure minimal disruption of intraoperative ECoG findings…

Intracranial Monitoring: Stereo-electroencephalography Recording

This chapter includes an accompanying slide presentation that has been prepared by the authors: Video 90.1 . Key Concepts Stereo-electroencephalography (SEEG) is a method of seizure localization for medically refractory epilepsy. The SEEG method is based on the principle of anatomo-clinical correlation. Intracranial data are acquired by intracortical depth electrode recordings used to analyze ictal and interictal epileptogenic activity. Among all methods of invasive monitoring, the…

Intracranial Monitoring with Subdural Grids and Strips

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 89.1 . Key Concepts Subdural grid and strip electrodes have been used in the presurgical evaluation for epilepsy surgery for more than half a century. They are useful for patients requiring intracranial electroencephalographic (EEG) monitoring for seizure localization through both interictal and ictal zone mapping and functional mapping. The implantation of…