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Commission on Neurosurgery

Chair & Contact Information:
Prof. H.G. Wieser
Neurologische Klinik und Poliklinik
Universitatsspital Zurich
Neurologische, Frauenklinikstrasse 26
CH-8091 Zurich, Switerland
Phone: +41 1 255 5531
Fax: +41 1 255 4429

Previously Formulated Goals/Specific aims

- 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 Commission.
- To assist the "Global Campaign".
- To liaise with the ILAE Commissions on Therapeutic Strategies (Chair Richard Mattson) - Subcommission Epilepsy Surgery (Claudio Munari+/ new liaison person shall be nominated) [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 JWA S Sander) with the Burden of Epilepsy - Subcommission on the implementation of adequate therapy, including neurosurgery in developing countries with the Commission on Pediatrics (Chair B.Dalla Bernardina) - Subcommission on Surgery and pre-surgical evaluation (Chair [Claudio Munari+]/ new liaison person shall be nominated) and the Working Group Pharmaco-resistance 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 person Bettina Schmitz; action taken by S.Koch-Stoecker/Bielefeld, Germany) 

The ILAE Commission for the Developing World (Chair Rajendra Kale; Commission Members: Hasan Aziz/Pakistan; Michel Dumas/France; Jaime Fandino Franky/Colobia; Peter Halasz/Hungary; Byung-In-Lee/Korea; Antonia Martins da Silva/Portugal; JWAS Sander/UK) There are liasions with the Commission on Diagnostic Strategies (Chair Martha Morrell, liasion Walter v.Emde-Boas) and with Commission on Therapeutic Strategies (Chair Richard Mattson; liasion [Claudio Munari +], as well as Paulo de Bittencourt and Esat Eskazan).

Unfortunately Claudio Munari died unexpectedly

List of subcommissions

Subcommission Corpus callosum section (John Gates)
Subcommission Vagus nerve stimulation (Paul Boon)
Subcommission Multiple subpial transsection (Susan Spencer)
Subcommission Radiosurgery for intractable epilepsy (Jean Regis - Charles Polkey)
Subcommission Paediatric epilepsy surgery (Hans Holthausen / Helen Cross)
Subcommission Outcome classification from the point of view of epilepsy surgery
(Heinz Gregor Wieser) Members: [Claudio Munari +], J.Engel, Walter van Emde Boas. Hans Holthausen, Cigdem Oezkara, Susan Spencer Joint Subcommission Epilepsy surgery in the developing world (Rajendra Kale - H Gregor Wieser) Members: Walter van Emde Boas, Jaime Fandino-Franky, Cigdem Oezkara, André Palmini, K. Radhakrishnan, Bhaskara Rao Malla, Luisa Rocha, Herbert Silvenius, Peter D. Williamson

Meetings held by the Commission:
Dec 7, 1999 : CNE, Orlando
Sept 15, 1999: CNE, Prague
Sept 14, 1999, Prague Meeting " ILAE Joint Subcommission Epilepsy Surgery in Developing Countries"

Status of reports and guidelines:
Commission on Neurosurgery of the International League against Epilepsy

1. (ILAE): Recommended Standards. With minimal changes this paper (formulated under the chairmenship of Charles Polkey and Colin Binnie) is now agreed on and has been submitted to Epilepsia for publication .

2. Outcome classification from the point of view of epilepsy surgery: Wieser has prepared a proposal "Classification of Outcome with Respect to Epileptic Seizures" which is the summary of a Satellite Workshop held on June 26, 1998, Cleveland, with the following participants: W.T.Blume, D.Fish, E.Goldensohn, A.Hufnagel, D.King, H.Lüders, M.R.Sperling, H.G.Wieser. This proposal was consequently discussed at the Dartmouth meeting between Lüders, King and Wieser and further circulated, among others, to J.Engel. It has been circulated among the members of the ILAE-CNE together with the comments of J.Engel, and a subcommission has agreed on it. It goes now to the ILAE Executive and possible publication in Epilepsia.

- Epilepsy Surgery in Developing Countries: The presentations at the Roundtable Conference of the ILAE Commissions on Epilepsy Surgery & Epilepsy Surgery in Developing Countries (organized by H. Silfvenius and H.G.Wieser) and some input from the Business Meeting of the ILAE Joint Subcommission on Epilepsy Surgery in Developing World resulted in several selected manuscripts which are presently edited by by H. Silfvenius and H.G.Wieser and ready to be sent for publication as a Supplementum to Epilepsia

- The Liaison group to the European Federation of Neurological Societies [EFNS] (Stefan, Wieser, Polkey) has stipulated a position paper on Minimal Standards for Epilepsy Surgery based on The "Recommended Standards" of the ILAE-CNE Commission (submitted to the ILAE Executive and dealt with ultimately at the Orlando Meeting)

- Presurgical Evaluation for Epilepsy Surgery - European Standards" . [Task Force members: Christoph Baumgartner/Vienna, Austria; Milan Bradzil/Brno, Czech Republic; Colin Binnie/London, England; Oliver de la Lande/Paris, France; Mogens Dam/Aarhus, Denmark; Jerzy Majkowski/ Warsaw, Poland; Charles Polkey/London, England; Antonio Russi/Barcelona, Spain; Johannes Schramm/Bonn, Germany; Hermann Stefan/Erlangen, Germany; Heinz Gregor Wieser/Zurich, Switzerland; Aarne Ylinen/Kuopio, Finland]. The draft has been submitted to European Neurology.

Contacts and interactions with other commissions:
Y. Comair, Beirut, Lebanon
J. Fandino-Franky, Cartagena, Colombia;
H.S. Hosny, Cairo, Egypt
Cigdem Oezkara, Turkey;
André Palmini, Porto Alegre, Brasil;
K. Radhakrishnan, Trivandrum, India;
M. Baskara Rao, Trivandrum, India;
Herbert Silfvenius, Umeå, Sweden;
V.P. Singh, AIIMS, Delhi, India;
Peter D. Williamson, Dartmouth, USA

Summary of your activities in the past year:
The work of several subcommissions working in the area Palliative epilepsy surgery, including vagal nerve stimulation, callosal sections, and multiple subpial transsections [Morrel-Whisler] resulted in the following draft papers:
- Régis J, Roberts D, Bartolomei F, Rey M, Hayashi M, Dravet C, Genton P, Bureau M, Gastaut J-L, Chauvel P, Peragut J-C. Role of gamma knife surgery in the treatment of severe epilepsy (discussed at Orlando)
- Boon P, Gates J. Vagus nerve stimulation for refractory epilepsy (discussed at Orlando)

At the Orlando Meeting we took notice and discussed the
- Proposal for evaluation of stereotactic radiosurgery in the treatment of drug-resistant epilepsy (Polkey CE, Binnie CD, Oxbury J, Kerr R, Kemeny A, Chadwick D, Duncan J)
and the paper of
- Pendl et al.: Corpus Callosotomy with radiosurgery. Neurosurgery 1999; 45:303-308

Plans for the coming year:
- Cigdem Oezkara‘s Meeting on MTLE
- Better definition of clinical epilepsy syndromes amenable to epilepsy surgery (Cigdem Oezkara). A special Workshop is planned by Cigdem Oezkara. A grant proposal has been submitted to ILAE for a satellite Meeting in Turkey on MTLE (by Oezkara, supported by the Commission CNE). This meeting will be held in 2000 provided that sufficient money can be raised. Cigdem Oezkara is in contact with the main Sponsor Sanofi. A Scientific Advisory Board has been nominated with G.Avanzini, Jerome Engel, Michael Sperling and H Gregor Wieser

The place of Vagal Nerve Stimulation versus Callosal Sections should be elaborated carefully by the nominated subcommission (chaired by Paul Boon) works on the formulation of inclusion and exclusion criteria of VNS. A liaison should be made with the Graz group (Schröttner) using Gamma Knife for CC-tomy.

Multiple subpial transsections [Morrel-Whisler]: A subcommission (chaired by Susan Spencer) started to work on the compilation of MST cases. The goal is the formulation of inclusion and exclusion criteria for MST.

  1. Jean Regis and Charles Polkey have contacted representatives of several epilepsy surgery programs to explore the possibility for a randomized study "Gamma-Knife Surgery versus classical Selective Amygdalohippocampectomy in MTLE 

  2. Special issues and a concrete plan action with regard to Pediatric epilepsy surgery; Intractable childhood epilepsy; and Migrational disorders (Hans Holthausen nominated J.H. Cross/London) is expected.

H. G. Wieser

Annual Report 2000 Table of Contents

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