Neurosurgery

Commission Members

Aims

To advise the ILAE Executive on issues related to neurosurgery of epilepsies.

Objectives

• To improve epilepsy surgery around the world
• To establish information on current and previous research in evaluating the effectiveness and value of various forms of surgical treatment, with particular emphasis on long-term outcome data and palliative as well as “experimental” procedures
• To identify areas of research that should be addressed by the ILAE
• To assist the Global Campaign
• To liaise with the ILAE Commissions on Therapeutic Strategies (Chair Richard Mattson) Subcommission

Epilepsy Surgery (Claudio Munari). Topics: Minimal requirements for the evaluation of patients prior to specific therapeutic interventions; Distribution of AEDs in surgical samples, etc. with the Burden of Epilepsy. Subcommission on Outcome Measures (Chair Gus A. Baker) and Subcommission on Projects related to the Global Campaign (Chair J.W.A. Sander) with the Burden of Epilepsy. Subcommission on the implementation of adequate therapy, including neurosurgery in developing countries (Chair Eskazan) with the Commission on Pediatrics (Chair B. Dalla Bernardina). Subcommission on Surgery and Pre-surgical Evaluation (Chair Claudio Munari) and the Working Group Pharmacoresistance which plans a workshop around the European Epilepsy Congress in Florence in 2000 with the Commission on Psychobiology (Chair Michael Trimble). Subcommission on Surgery (liaison Bettina Schmitz).

Achievements prior to July 2003

MTLE-HS Workshop, Istanbul, May 2002
Subcommission on Pediatric Epilepsy Surgery, 2003 Dordogne Meeting

Working Group on MEG, May 3-5, 2003 Erlangen Meeting

Subcommission on Callosotomy and Vagal Nerve Stimulation

Gates has written a draft outline, which was discussed at several meetings of the Commission.

Subcommission on Radiosurgery

Regis and Polkey have written a paper. In Lisbon it was decided that the updated report should be published.

Subcommission on Epilepsy Surgery in the Developing Countries

Activities on this issue are proceeding well and Williamson will report his experiences with Deep Brain Stimulation.

At the Lisbon meeting it was decided that the Commission should try to explore with the investigators involved the need for a subcommission or working group on this subject. Thus far, however, little has come out of this.

Multiple Subpial Transsection

In Lisbon a working group was constituted. Susan Spencer has published the results of her survey.

Commission Activities July 31, 2003 to June 30, 2004

MTLE-HS Workshop, Istanbul, May 2002
Wieser has finalized the definitive version of the texts of the discussion groups and the summary, with review for the English language by Polkey and Mathern. It has been sent to Epilepsia and is now published (Wieser HG for the ILAE Commission on Neurosurgery of Epilepsy. ILAE Commission Report. Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis. Epilepsia 2004: 45:695-714).

Subcommission on Pediatric Epilepsy Surgery

A draft paper summarizing the discussions, conclusions and suggestions of the 2003 Dordogne meeting has been prepared and has been circulated twice among the participants for additional comments.

Working Group on MEG

Baumgartner and Stefan intend to publish the paper resulting from the Erlangen meeting.

Subcommission on Callosotomy and Vagal Nerve Stimulation

Gates has rewritten the previous draft and included more basic science data and the data from Tanaka’s work.

Subcommission on Radiosurgery

Although both the commission and the E.B. formally accepted the report prepared earlier by Regis and Polkey, this paper somehow never was forwarded to the board or to Epilepsia. Regis has published his most recent results in a regular paper and at present is predominantly occupied with the international multicenter study on Gamma-knife treatment of MTLE, which he is coordinating.

Working Group on Multiple Subpial Transsection

The present working group continued to pursue
this issue.

Proposals for Sessions during the Paris Congress

Wieser has been asked to submit a proposal for a session: The “epileptogenic zone” versus the “epileptogenic network” concept.

Subcommission on Pediatric Epilepsy Surgery

The final draft of the 2003 Dordogne meeting now is about ready to be sent out to the main commissions involved (Epilepsy Surgery and Pediatrics) for
further review preceding the submission to the ILAE Executive Board. The main focus in the discussions/paper was to identify those issues where pediatric epilepsy surgery significantly differs from adult epilepsy surgery, with special emphasis on presurgical evaluation, including the technology involved, and on outcome measures.

The latter two will be further discussed during a second meeting, to be organised as a satellite in conjunction with a meeting in San Francisco in March or April 2005 and the results are to be presented at the next world congress in Paris. Helen Cross should communicate at short notice with the organising committee of the Paris meeting to arrange such a meeting.

The paper will be posted on the ILAE website as soon as it has passed the Commissions.

Subcommission on Callosotomy and Vagal Nerve Stimulation

Gates is waiting for the final comments and possible additions from Boon. Gates expects to have the final draft ready for circulation within the next month or so.

Subcommission on Radiosurgery

An international multicenter study on Gamma-knife treatment of MTLE is coordinated by Jean Regis. Regis is asked again to provide an updated version of the earlier draft on Gamma knife treatment of MTLE. (In Lisbon it was already decided that the updated report would not need to be submitted again to the ILAE Executive Board.)

Subcommission on Epilepsy Surgery in the Developing Countries
The activities on this issue will be reported to the commission in more detail at some other occasion. Williamson will report his experiences in South America at the July 2004 Latin American Epilepsy Congress in Mexico.

Deep Brain Stimulation

The Commission decided at the Vienna Meeting to let this issue wait for further discussion at the strategic meeting in New Orleans.

New Activities

Given the new information on the upcoming strategic meeting in New Orleans the Commission decided that for the time being the commision will
continue its current activities, including those of the existing subcommissions and working groups but will not initiate any new activities.

Strategic meeting of the chairpersons of all ILAE commissions to be held prior to the American Epilepsy Association Meeting in New Orleans, December 2004 (Announcement of the ILAE President). The chairperson of the Neurosurgery Commission intends to participate.

International Summer Schools on Epilepsy at San Servolo in 2005 and 2006 devoted to the subjects of Basic Clinical Sciences and Epilepsy Surgery/Diagnostic Strategies (Announcement of the ILAE President). The members of the Neurosurgery Commission intend to participate.

Sessions during the Paris Congress

Apart from the “epileptogenic zone” versus the “epileptogenic network” concept session, the previously mentioned subjects (Pediatric Epilepsy Surgery guidelines and Multiple Subpial Transection guidelines) will be proposed to the organisers and the Commission will try to obtain slots for such sessions.

The next Business Meeting of the Commission will be held at the time of the upcoming AES meeting in New Orleans, if possible on Friday 3 December, at the end of the afternoon or early in the evening.

H.G. Wieser
Chair