1. EPILEPSY TREATED WITH GAMMA KNIFE

2. EPILEPSY Epilepsy is a common chronic neurological disorder that is characterized by recurrent unprovoked seizures. It is a group of syndromes with vastly divergent symptoms. Involves episodic abnormal electrical activity in the brain. Types of Epilepsy: Febrile seizures Benign Rolandic Epilepsy Childhood Epilepsy Juvenile Absence Epilepsy Juvenile Myoclonic Epilepsy Infantile Spasms Lennox-Gastaut Syndrome Reflex epilepsies Temporal Lobe Epilepsy Frontal Lobe Epilepsy Progressive Myoclonic Epilepsy Mitochondrial Disorders Landau-Kleffner Syndrome Ring Chromosome 20 Syndrome Hypothalamic Hamartoma

3. WHAT’S THE COMMON FACTOR???

4. Treatment of Epilepsy Medication Implantation of a vagus nerve stimulator Special diet Neurological operations for epilepsy which can be either palliative or curative A new alternative method of treatment has been introduced which uses Gamma knife radiosurgery (using finely foccussed beams of radiation instead of using a real surgeon’s knife) It is a non-invasive procedure of treatment of epilepsy Epilepsy patients with seizures resistent to medication are treated by GKS It is mainly seen in the treatment of Mesial Temporal Lobe Epilepsy (MLTE) May also be used in the treatment of hypothalamic hamartomas and hippocampal sclerosis It is also seen to be an effective treatment in pediatric epilepsy

5. EPILEPSY TREATED WITH GAMMA KNIFE

6. GAMMA KNIFE The gamma knife device contains 201 cobalt-60 sources of approximately 30 curies eachcobalt-60curies It is placed in a circular array in a heavily shielded assembly. shielded The device aims gamma radiation through a target point in the patient's brain.gamma radiation The patient wears a specialized helmet that is surgically fixed to their skull so that the brain tumor remains stationary at target point of the gamma rays. Therefore it is also known as the stereotactic surgery.

7. GAMMA KNIFE

8. Patients eligible for Gamma Knife therapy Mostly patients with seizures originating in the mesial temporal lobe can undergo treatment with the Gamma Knife. In initial evaluation a patient is fitted with electrodes and then allowed to have typical seizures over several days, in a protected environment. Physicians monitor brain waves and record patient responses with video and audio. Patients are deemed ineligible for surgery if seizures come from multiple areas of the brain. If the seizures originate within either the left or right temporal lobes (located on the sides of the brain), and additional MRI scans verify the location, patients are potential candidates for surgery. Some patients need a second round of monitoring with electrodes placed inside the skull to more precisely identify the area of disorder. Final testing to verify that the disorder affects only one side of the brain, and not both, will determine the candidate’s eligibility.

9. ADVANTAGES More effective than surgical resection which has a very high amount of risk factors Has very rare side effects, often transient and easily detectable Less costly method Can be considered as an alternative when very deep seated and small lesions are present Increased alertness, elevated mood, and greater speech production,positive effect on sleep patterns in younger patients

10. PRE AND POST GAMMA KNIFE SURGERY

11. Side-effects of Gamma knife therapy Adverse effects were few and consist of: Headache Nausea Vomiting Visual field deficits

12. CONCLUSION In patients with over 2 years of follow-up, the overall rate of seizure freedom was 81%, with 12%improved and 7% unchanged GKS is a non-invasive procedure which does not involve risks associated with surgical resection.

13.  Gamma Knife surgery is mainly used in those patients : Who are resistant to medications In patients who have very deep seated and small lesions in the brain In patients with localized epileptogenic zones. It is mainly effective in the treatment of Mesial Temporal Lobe Epilepsies (MTLE).

14. SEARCH STRATEGY

15. KEYWORDS Epilepsy “Gamma knife”

16. DATABASES & SEARCH TOOLS A Database is a structured collection of records or data. A computer database relies upon software to organize the storage of data.structureddatacomputersoftware A Search engine is designed to search for information on the World Wide Web. Information may consist of web pages, images and other types of files. Some search engines also mine data available in newsgroups, databases, or open directories.World Wide Webweb pagesopen directories

17. PROCESS OF SEARCH

18. TYPES OF DATABASES ABSTRACT DATABASE: A database comprising a collection of scholarly abstracts. FULL-TEXT DATABASE: A database comprising of information source from cover to cover full-text articles. PATENT DATABASE: A database which provides access to issued and applied patents.

19. DATABASES WE USED ABSTRACT DATABASE: Pubmed, since it is a key database for healthcare professionals. FULL-TEXT DATABASE: Ovid LWW, a leading fulltext resource for professionals and students of medicine, nursing, allied health and pharmacy PATENT DATABASE: Patentlens

21. SEARCH PROCESS

22. ABSTRACT DATABASE Pubmed: Use Pubmed basic search. Use search MeSH = Epilepsy and find 27 results. I selected the first result and narrowed the search to major subheadings, namely: Radiotherapy, Surgery and Therapy I restricted the search to these subheadings and combined another search term “gamma knife” by selecting the option Send to Search Box with AND, and searched PubMed. I got 53 results in all-out of which 2 are free full text and 16 are from Southern Medical University Library. I referred to these 18 full text results to research for my topic.

24. Click on this link

28. FULL-TEXT DATABASE Ovid LWW: Firstly, we select the database SMUJournal@Ovid. We choose the Advanced Ovid Search and use the Title field using epilepsy AND gamma knife, and search to find 5 results.

30. Select title

32. Patentlens: Use Structured Search to find patents having epilepsy AND “gamma knife” in Title field, but found zero results. To broaden the search, find patents with epilepsy AND “gamma knife” in Full-Text to get 33 results.

37. RELEVANT CITATIONS PUBMED: 1 Bartolomei F, Hayashi M, Tamura M, Rey M, Fischer C, Chauvel P, Régis J. Long-term efficacy of gamma knife radio surgery in mesial temporal lobe epilepsy. Neurology. 2008 May 6; 70(19):1658-63. Epub 2008 Apr 9. PMID: 18401026 [PubMed - indexed for MEDLINE] 2 Régis J, Scavarda D, Tamura M, Villeneuve N, Bartolomei F, Brue T, Morange I, Dafonseca D, Chauvel P. Gamma knife surgery for epilepsy related to hypothalamic hamartomas. Semin Pediatr Neurol. 2007 Jun; 14(2):73-9. Review. PMID: 17544950 [PubMed - indexed for MEDLINE] 3 Eder HG, Feichtinger M, Pieper T, Kurschel S, Schroettner O. Gamma knife radio surgery for callosotomy in children with drug-resistant epilepsy. Childs Nerv Syst. 2006 Aug; 22(8):1012-7. Epub 2006 Jun 13. PMID: 16770617 [PubMed - indexed for MEDLINE] 4 Grabenbauer GG, Ernst-Stecken A, Ganslandt O, Stefan H. Gamma knife surgery in mesial temporal lobe epilepsy. Epilepsia. 2005 Mar;46(3):457; author reply 457-9. No abstract available. PMID: 15730549 [PubMed - indexed for MEDLINE] 5 Dunoyer C, Ragheb J, Resnick T, Alvarez L, Jayakar P, Altman N, Wolf A, Duchowny M. The use of stereotactic radio surgery to treat intractable childhood partial epilepsy. Epilepsia. 2002 Mar; 43(3):292-300. PMID: 11906515 [PubMed - indexed for MEDLINE] 6 PATENTLENS: 1 US 2005/0049486 A1 patent application Title:Method for performing stereotactic radiosurgery

38. THANK YOU Presented by: Aparajita Kumar(43) Archita Gupta(42) Other members: Sangeet Komal(38) Wilanika M. Bamon(37)