Epilepsy Surgery

For those with epilepsy, finding a treatment that controls seizures is key. Medications are often the first choice, but they don’t work for everyone. If seizures keep happening after trying many drugs, surgery might be an option.

Epilepsy surgery aims to remove or change the brain area where seizures start. It aims to cut down or stop seizures, making life better for the patient.

In this guide, we’ll look at the different types of epilepsy surgery. We’ll also cover the evaluation process and what happens before, during, and after surgery. We’ll talk about the good and bad sides of surgery as a treatment for seizures.

Understanding Epilepsy and When Surgery is Considered

Epilepsy is a brain disorder that causes seizures. These seizures happen when the brain’s electrical activity goes wrong. Knowing the signs of epilepsy is key for quick diagnosis and treatment.

What is Epilepsy?

Epilepsy is a long-term condition that affects the brain’s electrical signals. A person is said to have epilepsy after having two or more seizures without a clear cause. These seizures can be different in how intense and long they last, and may include losing consciousness or having uncontrollable movements.

Signs and Symptoms of Epilepsy

The symptoms of epilepsy can differ from person to person. Some common epilepsy symptoms include:

• Staring spells
• Temporary confusion
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychological symptoms such as fear, anxiety, or déjà vu

When is Epilepsy Surgery an Option?

For many, medicines can control seizures well. But about 30% of people have drug-resistant epilepsy, where seizures keep happening even after trying many medicines. For these people, surgery might be an option.

Surgical candidates go through a detailed check before surgery. This check includes:

• Detailed medical history and neurological examination
• EEG monitoring to find where seizures start
• MRI and PET scans to look for brain problems
• Neuropsychological testing to check brain function

If tests show seizures start from a specific brain area, and surgery could help more than harm, the person might be a good candidate for surgery.

Types of Epilepsy Surgery

Epilepsy surgery is a group of procedures aimed at reducing or stopping seizures in those with drug-resistant epilepsy. There are three main types: resective, disconnective, and neuromodulation surgeries. Each targets different brain areas where seizures start.

Resective Surgery

Resective surgery removes the brain part where seizures start. The most common is temporal lobectomy, focusing on the temporal lobe. It’s very effective, with up to 70% of patients becoming seizure-free.

Other resective surgeries include frontal, parietal, and occipital lobe resections. These depend on where the seizure focus is.

Disconnective Surgery

Disconnective surgery cuts off seizure pathways in the brain. Corpus callosotomy is a key procedure that severs the corpus callosum. This is for severe, generalized seizures not controlled by other means.

While it doesn’t stop seizures, it can make them less frequent and severe.

Neuromodulation Procedures

Neuromodulation uses electrical stimulation to control brain activity and reduce seizures. Two main therapies are Vagus Nerve Stimulation (VNS) and Responsive Neurostimulation (RNS).

The right surgery depends on several factors. These include seizure type and location, patient health, and the risks and benefits of each option. A detailed pre-surgical evaluation is key to finding the best surgery for each patient.

Pre-Surgical Evaluation Process

Before surgery for epilepsy, patients must undergo a detailed evaluation. This step is to see if they can have surgery. It includes tests to find where seizures start in the brain. This helps doctors plan the surgery safely.

Brain mapping is a big part of this. It uses functional MRI to map the brain. This way, doctors can see important areas and avoid them during surgery.

Neuropsychological testing is also key. It checks how well the brain works. This helps doctors understand what surgery might change. It also helps plan how to help the patient after surgery.

The Wada test might be used too. It checks how each brain side works. A special drug is used to “sleep” one side, then the patient does tasks. This test makes sure surgery won’t harm too much.

This whole process is a team effort. Doctors, neurosurgeons, and others work together. They make sure each patient gets the best care for their needs.

Temporal Lobectomy: The Most Common Epilepsy Surgery

Temporal lobectomy is the most common surgery for epilepsy, mainly for temporal lobe epilepsy. It involves removing part of the temporal lobe. This is where many seizures start.

What is Temporal Lobectomy?

An anterior temporal lobectomy removes the front part of the temporal lobe. This includes the amygdala and hippocampus. These areas are key for memory and emotions. But, in some with temporal lobe epilepsy, they can cause seizures.

Candidates for Temporal Lobectomy

Temporal lobectomy is for those who:

Recovery and Outcomes

Patients usually stay in the hospital for 2-4 days after surgery. It can take 4-8 weeks to fully recover. About 60-70% of patients stop having seizures completely after surgery.

But, some might need to keep taking medicine, though at lower doses. Temporal lobectomy is a big surgery with risks and side effects. It’s important to carefully consider if it’s right for each person.

Vagus Nerve Stimulation (VNS) Therapy

For those with epilepsy who can’t have surgery, neuromodulation like Vagus Nerve Stimulation (VNS) therapy is a good choice. A small device, like a pacemaker, is placed under the skin of the chest. It sends mild electrical pulses to the vagus nerve in the neck, helping to control brain activity.

The aim of VNS therapy is to lessen the number and severity of seizures. It might not stop seizures completely, but many see a big drop in seizure frequency. The device sends signals at set times, and patients can also use a magnet to start it when a seizure is coming.

VNS is for those who’ve tried many medicines without success. It works for kids and adults with focal or generalized epilepsy. It’s a good choice for those who can’t have surgery because of where their seizures start.

The Vagus Nerve Stimulator is put in during a quick, outpatient surgery under general anesthesia. Most people do well with the device, with side effects like hoarseness and coughing that usually go away. Regular check-ups are needed to adjust the device and see how it’s working.

Responsive Neurostimulation (RNS) System

The Responsive Neurostimulation (RNS) System is a new device for treating epilepsy. It watches brain activity and sends electrical signals to stop seizures before they start.

How the RNS System Works

The RNS System has a small device implanted in the brain. It has leads that connect to the part of the brain where seizures start. The device checks brain activity all the time.

It uses special algorithms to spot seizure patterns. When it finds one, it sends electrical pulses to stop the seizure. This way, treatment only happens when it’s needed.

The system also saves data on brain activity. This helps doctors understand and improve treatment plans.

Benefits and Risks of RNS

The RNS System has many benefits for people with epilepsy:

• Less frequent and severe seizures
• Improved life quality
• Less invasive surgery than traditional options
• Treatment can be adjusted or reversed
• It helps monitor and analyze brain activity

But, like any surgery, there are risks:

• Infection
• Bleeding
• Pain at the implant site
• Device malfunction
• Side effects like tingling or dizziness

Despite these risks, many patients find the benefits of RNS worth it. Talking to an epilepsy specialist is key to deciding if RNS is right for you.

Laser Ablation for Epilepsy Treatment

Laser ablation, or MRI-guided laser ablation, is a new minimally invasive surgery for drug-resistant epilepsy. It uses laser energy to destroy brain tissue that causes seizures. This is done without open brain surgery.

A thin laser probe is inserted through a small skull incision. It’s guided by MRI to the brain area needing treatment. The laser heats and destroys the bad tissue, keeping the healthy brain safe. The team watches closely to make sure it’s done right.

Laser ablation is great for focal epilepsies like temporal lobe epilepsy. It’s also for those who can’t have open surgery. This is because the seizure focus is clear and reachable.

Like any surgery, laser ablation has risks like bleeding and infection. But, it’s less risky and quicker to recover from than open surgery. People who get MRI-guided laser ablation often see a big drop in seizures. This makes their life much better.

Corpus Callosotomy and Hemispherectomy

For those with severe epilepsy that doesn’t get better with meds or other surgeries, disconnective surgery might be an option. Procedures like corpus callosotomy and hemispherectomy aim to stop seizures from spreading. They help people with severe seizures, like drop attacks, caused by catastrophic epilepsy.

Corpus Callosotomy Procedure and Outcomes

Corpus callosotomy cuts the corpus callosum, the nerve fibers connecting the brain’s hemispheres. This surgery stops seizures from spreading, reducing drop attacks. It’s done in two stages, cutting the front part first, then the back if needed.

Many people see a big drop in drop attacks and feel better after this surgery. But, some might face temporary issues with moving their body. These problems usually get better with time and practice.

Hemispherectomy: When is it Necessary?

In extreme cases of epilepsy, where seizures are very dangerous, hemispherectomy might be the only choice. This surgery removes or disconnects one hemisphere of the brain. It’s a last resort for severe cases.

People needing this surgery often have a damaged hemisphere. This damage can be from conditions like:

Hemispherectomy is a big surgery, but it can change lives. Many patients stop having seizures and see big improvements in thinking and feeling. The brain’s ability to adapt helps the remaining part take over, leading to recovery and a better life.

Risks and Complications of Epilepsy Surgery

Epilepsy surgery can change lives for many. But, it’s key to know the risks and complications. Talking about these with your doctor is important before surgery.

General risks include infection, bleeding, and bad reactions to anesthesia. The risks depend on the surgery type. Some possible problems are:

Some patients might face neurological issues like weakness or language problems after surgery. These can be short-term or permanent, based on the surgery’s extent.

It’s vital to consider the surgery’s benefits against its risks and complications. Your surgical team will help reduce risks. They’ll also provide care before and after surgery to support your recovery.

Life After Epilepsy Surgery: What to Expect

After epilepsy surgery, patients might see better seizure control and a higher quality of life. The amount of improvement varies, but many see a big drop in seizures or even no seizures at all. This freedom can open up new chances to do things they once avoided.

It’s key to keep up with follow-up care to track progress and ensure the best results. Patients will see their neurosurgeon and neurologist regularly. They might also need physical, occupational, or speech therapy to regain skills or adapt to changes.

Adjusting to life after surgery can bring emotional and psychological challenges. Feelings like anxiety, depression, or loss are common. Support from loved ones, healthcare teams, and support groups is vital. Counseling can also help patients deal with these feelings and connect with others who’ve gone through similar things.

Epilepsy surgery can greatly improve life, but it’s important to have realistic hopes. Recovery takes time. With the right care, support, and rehabilitation, patients can thrive and seize new opportunities.