Drug-resistant epilepsy (DRE) is defined as failure of two adequate trials of appropriately chosen and administered antiepileptic drugs. Approximately about 30% of epilepsy patients are drug resistant. Accountable reasons to treatment failure including failure to recognize epilepsy syndrome, poor drug compliance, lifestyle factors, etc. In modern era of medicine, DRE patient should be encouraged to have early referral to tertiary epilepsy centre for presurgical evaluation. Comprehensive neurophysiology, structural neuroimaging, and neuropsychological and psychiatric assessment are regarded as essential elements. Invasive electroencephalography (EEG) monitoring in terms of subdural electrodes, depth electrodes, foramen ovale electrodes, and more advanced technique using stereoelectroencephalography (SEEG) are strong armamentarium for epilepsy surgeon. Epilepsy surgery in terms of resection, disconnection, or neuro-modulation should be recommended after a multi-disciplinary agreement.
Part of the book: Epilepsy
Meningiomas are the second common Central Nervous System (CNS) neoplasm, and are the most common benign intracranial tumor. They approximately constitute up to 30% of all intracranial tumors. They arise from the arachnoidal coverings of brain. Presentation varies and depends on size, number and location of tumors. Symptoms include those related to increased in intracranial pressure, local irritative features including seizure and local pressure effect to eloquent areas, white matter tracts and cranial nerves. Management of meningiomsa is always challenging and multi-disciplinary approaches includes surgery, radiotherapy and possible chemotherapy and immunotherapy. Among radiation therapy treatment, stereotactic radiosurgery (SRS) or stereotactic radiosurgery (SRT) is getting the popularity compared to traditional conformal radiotherapy with comparable tumor control rate.
Part of the book: Brain Tumors