Conditions Treated 

Epilepsy

Epilepsy is a medical disorder recorded throughout human history.  It is one of the most common disorders of the nervous system, affecting nearly 50 million people of all ages, races and ethnic backgrounds.  More than 2.7 million Americans live with epilepsy, and each year nearly 181,000 Americans develop seizures and epilepsy for the first time. Epilepsy can develop at any time of life, especially in early childhood and old age. There are more than 21 types of seizures.

Medical Treatment
A deeper understanding of neurophysiology and electrochemistry has led to the development and introduction of several new drugs that allow pharmacologic control of seizures in 70 to 80 percent of newly diagnosed children and adults in the United States.

Surgical Treatment
Neurological surgeons see the 20 to 30 percent of epilepsy patients who have not responded to aggressive treatment with medication. Although surgical treatment has been used for more than a century, its increased use since the 1980s reflects its effectiveness. More recently, surgery is considered earlier because studies have shown better outcomes. Surgery can be especially beneficial to patients whose seizures are associated with structural brain abnormalities, such as medial temporal lobe sclerosis or mass-occupying lesions.

At Ohio State, treatment is delivered by a multidisciplinary team of physicians.  Close collaboration between the Department of Neurological Surgery and the Department of Neurology's epileptologists allows appropriate selection of surgical candidates.

Presurgical evaluations include detailed patient histories, radiographic imaging with high magnetic-field strength MR imaging, and video electroencephalographic monitoring through both noninvasive scalp and neurosurgically placed intracranial electrodes. Patients whose seizures reveal clear focality are then offered a surgical option for managing intractable seizures. When appropriate, neurosurgeons can perform resections in awake patients to enhance outcomes.

Parkinson's Disease and Other Conditions

The term “movement disorder” covers a wide variety of neurological conditions, including Parkinson's disease.  Parkinson's disease was named after James Parkinson, a general medicine practitioner in London who is credited with the first complete description of the symptoms and progression of the disease. Dr. Parkinson's 1817 report, "Essay on the Shaking Palsy," describes six patients who had what appeared to be one condition characterized by symptoms such as rigidity, tremors, an accelerated gait and stooped posture.

Parkinson's disease is a common neurological disorder that affects approximately 1 percent of individuals older than 60 years. It is approximately 1.5 times more common in men than women, and onset before age 40 is relatively uncommon. The diagnosis of Parkinson's disease remains clinical with the three cardinal signs being resting tremors, rigidity and bradykinesia (slowed movement) – the hallmarks Dr. Parkinson noted nearly two centuries ago. Two of the three are required to make a clinical diagnosis. Postural instability is a fourth diagnostic feature, but it emerges late in the course of the disease.

Medical Treatment
The pathophysiologic lesion in Parkinson's disease is the loss of dopaminergic neurons within a crucial deep brain nucleus known as the substantia nigra. The substantia nigra is part of a “motor loop” that normally provides smooth, controlled muscle movement. Though everyone loses some dopamine-producing neurons as a normal part of aging, people with Parkinson's disease lose half or more neurons in the substantia nigra. Not surprisingly, the medical treatment for people with Parkinson's involves supplanting the brain's dopamine deficiency with the medication Sinemet® (levodopa/carbidopa), which provides the central nervous system with a dopamine precursor. For many with Parkinson's, the initial response to therapy can be dramatic, but over time the benefits of drugs frequently diminish or become less consistent.

Surgical Treatment, including Deep Brain Stimulation
At this stage, neurological surgical intervention can prove beneficial. At Ohio State, treatment is delivered by a multidisciplinary team of physicians.

Surgical treatment of Parkinson's has generally consisted of making lesions in sites along the aforementioned “motor loop,” such as a thalamotomy or a pallidotomy. A relatively new alternative to these necessarily destructive procedures is deep brain stimulation (DBS), which is nondestructive and, if ineffective, reversible.