Adams had two emergency surgeries, including a colon resectioning, and Jacobs had two emergency surgeries and was hospitalized for 14 days.
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Surgical intervention is suitable for patients with refractory epilepsy. Specifically, the patients undergo partial resectioning of the part of the brain that generates a seizure. This region is identified by imaging techniques like EEG. For patients who are not suitable to undergo a resectioning treatment, deep brain stimulation and vagus nerve stimulation may be effective alternatives; however, results suggest that it is often difficult for both deep brain and vagus nerve stimulation to completely stop seizures.
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When Palahniuk asked him how he stayed so thin, he told him "I had a massive bowel resectioning." When Palahniuk asked what he meant, he told him the story which was the basis for the third episode in "Guts".
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ECoG is also performed following the resectioning surgery to detect any remaining epileptiform activity, and to determine the success of the surgery. Residual spikes on the ECoG, unaltered by the resection, indicate poor seizure control, and incomplete neutralization of the epileptogenic cortical zone. Additional surgery may be necessary to completely eradicate seizure activity.
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EEG findings were further validated by the surgical outcomes of all three patients. After surgical resectioning, two patients are seizure-free and the third has experienced a significant reduction in seizures. Due to its clinical success, FINE offers a promising alternative to preoperative ECoG, providing information about both the location and extent of epileptogenic sources through a noninvasive imaging procedure.
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During the resectioning surgery, intraoperative ECoG may also be performed to monitor the epileptic activity of the tissue and ensure that the entire epileptogenic zone is resectioned. Although the use of extraoperative and intraoperative ECoG in resectioning surgery has been an accepted clinical practice for several decades, recent studies have shown that the usefulness of this technique may vary based on the type of epilepsy a patient exhibits. Kuruvilla and Flink reported that while intraoperative ECoG plays a critical role in tailored temporal lobectomies, in multiple subpial transections (MST), and in the removal of malformations of cortical development (MCDs), it has been found impractical in standard resection of medial temporal lobe epilepsy (TLE) with MRI evidence of mesial temporal sclerosis (MTS). A study performed by Wennberg, Quesney, and Rasmussen demonstrated the presurgical significance of ECoG in frontal lobe epilepsy (FLE) cases.
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ECoG was pioneered in the early 1950s by Wilder Penfield and Herbert Jasper, neurosurgeons at the Montreal Neurological Institute. The two developed ECoG as part of their groundbreaking Montreal procedure, a surgical protocol used to treat patients with severe epilepsy. The cortical potentials recorded by ECoG were used to identify epileptogenic zones – regions of the cortex that generate epileptic seizures. These zones would then be surgically removed from the cortex during resectioning, thus destroying the brain tissue where epileptic seizures had originated.
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This followed from the work of Willebrord Snell in 1615–17, who showed how a point could be located from the angles subtended from three known points, but measured at the new unknown point rather than the previously fixed points, a problem called resectioning. Surveying error is minimized if a mesh of triangles at the largest appropriate scale is established first. Points inside the triangles can all then be accurately located with reference to it. Such triangulation methods were used for accurate large-scale land surveying until the rise of global navigation satellite systems in the 1980s.
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Epilepsy is currently ranked as the third most commonly diagnosed neurological disorder, afflicting approximately 2.5 million people in the United States alone. Epileptic seizures are chronic and unrelated to any immediately treatable causes, such as toxins or infectious diseases, and may vary widely based on etiology, clinical symptoms, and site of origin within the brain. For patients with intractable epilepsy – epilepsy that is unresponsive to anticonvulsants – surgical treatment may be a viable treatment option. ;Extraoperative ECoG Before a patient can be identified as a candidate for resectioning surgery, MRI must be performed to demonstrate the presence of a structural lesion within the cortex, supported by EEG evidence of epileptogenic tissue.
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Extraoperative ECoG is also used to localize functionally-important areas (also known as eloquent cortex) to be preserved during epilepsy surgery. Motor, sensory, cognitive tasks during extraoperative ECoG are reported to increase the amplitude of high-frequency activity at 70–110 Hz in areas involved in execution of given tasks. Task-related high-frequency activity can animate ‘when’ and ‘where’ cerebral cortex is activated and inhibited in a 4D manner with a temporal resolution of 10 milliseconds or below and a spatial resolution of 10 mm or below. ;Intraoperative ECoG The objective of the resectioning surgery is to remove the epileptogenic tissue without causing unacceptable neurological consequences.
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In addition to identifying and localizing the extent of epileptogenic zones, ECoG used in conjunction with DCES is also a valuable tool for functional cortical mapping. It is vital to precisely localize critical brain structures, identifying which regions the surgeon must spare during resectioning (the “eloquent cortex”) in order to preserve sensory processing, motor coordination, and speech. Functional mapping requires that the patient be able to interact with the surgeon, and thus is performed under local rather than general anesthesia. Electrical stimulation using cortical and acute depth electrodes is used to probe distinct regions of the cortex in order to identify centers of speech, somatosensory integration, and somatomotor processing.
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At the ceremony, the veterans stand solemnly and remove their hats as The Last Post sounds over them and echoes through rooms of companies stricken with palsy, amputatations, resectioning, and senility. A light-show of night combat flares over the screen with searchlights, bombardment and incineration accompanied by an acid rock raga. Final scenes include a few old friends who watch a BBC documentary of their campaigns with little reaction and a compilation of 1944 liberation sequences, returning to wards of bedridden and semi-conscious veterans. An elderly little man sings "God Save the Queen" facing the viewer and then says "I'm tired now, put me to bed" as the camera zooms in for a close up of his face.
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