Epilepsy Surgery

Epilepsy Surgery

Epilepsy surgery is an operation on the brain to control seizures and improve the person's quality of life. Epilepsy surgery involves a neurosurgical procedure where an area of the brain involved in seizures is either resected, disconnected or stimulated. The goal is to eliminate seizures or significantly reduce seizure burden. Approximately 60% of all people with epilepsy have focal epilepsy syndromes. In 15% to 20% of these patients, the condition is not adequately controlled with anticonvulsive drugs. Such patients are potential candidates for surgical epilepsy treatment.

First line therapy for epilepsy involves treatment with anticonvulsive drugs, also called antiepileptic drugs. Most patients will respond to one or two different medication trials. The goal of this treatment is the elimination of seizures, since uncontrolled seizures carry significant risks, including injury and sudden death. However, in up to one third of patients with epilepsy, medications alone do not eliminate seizures, and/or cause adverse effects. In these patients, epilepsy surgery is considered as an alternate treatment method to medications.

There are three main types of epilepsy surgery:

1.Surgery to remove the area of the brain producing seizures

2.Surgery to interrupt the nerve pathways through which seizure impulses spread within  

    the brain

3.Surgery to implant a device used to treat epilepsy

Surgery is considered only if the area of the brain where the seizures start, called the seizure focus, can be clearly identified, and if the area to be removed is not responsible for any critical functions, such as language, sensation and movement. Extensive evaluation and testing are necessary to determine if surgery is appropriate.

Who Is a Candidate for Epilepsy Surgery?

Surgery may be an option for people with epilepsy whose seizures are disabling and/or are not controlled by medication, or when the side effects of medication are severe and greatly affect the person's quality of life. Patients with other serious medical problems, such as cancer or heart disease, usually are not considered for epilepsy surgery.

How Effective Is Epilepsy Surgery?

The effectiveness varies, depending on the type of surgery. Some people are completely free of seizures after surgery. For others, the frequency of seizures is significantly reduced. In some cases, surgery may not be successful and a second surgery (re-operation) may be recommended. Most patients will need to continue taking anti-seizure medication for a year or more after surgery. Once seizure control is established, medications may be reduced or eliminated.