Epilepsy is a neurological disorder characterized by recurrent seizures that can significantly affect daily life. For many patients, medications can effectively control seizures, but for others, seizures persist despite trying multiple treatments. In such cases, brain surgery may be considered as a viable option to control seizures and improve quality of life.
When Is Brain Surgery for Epilepsy Considered?
Brain surgery is usually recommended for patients who have medically refractory epilepsy—seizures that do not respond to at least two different anti-seizure medications. Surgery may also be considered if:
- Seizures are frequent and significantly impact quality of life.
- The source of the seizures can be clearly identified in the brain.
- The seizures are localized to one part of the brain, making them amenable to surgery.
- Other treatment options, such as a ketogenic diet or neurostimulation, have not been effective.
Before surgery, patients typically undergo a thorough evaluation that may include brain imaging, electroencephalogram (EEG), and in some cases, invasive monitoring to identify the precise location of the seizure focus.
Types of Brain Surgery for Epilepsy
There are several types of brain surgery for epilepsy, including:
- Resective Surgery: This is the most common type of brain surgery for epilepsy. It involves removing the part of the brain where seizures originate. For example, if seizures are traced to the temporal lobe, a temporal lobectomy may be performed.
- Laser Interstitial Thermal Therapy (LITT): This minimally invasive surgery uses a laser to destroy the tissue where seizures originate. It’s typically used for patients with seizures in deeper brain areas or those who may not be candidates for traditional surgery.
- Corpus Callosotomy: This procedure involves cutting the corpus callosum, the connection between the two halves of the brain, to prevent seizures from spreading between hemispheres. It’s typically considered for patients with severe generalized seizures.
- Hemispherectomy: In rare cases, if seizures are severe and originate from one hemisphere of the brain, a hemispherectomy may be considered. This involves removing or disconnecting part of the
What to Expect Before, During, and After Surgery
Before Surgery:
- Pre-surgical Evaluation: This includes a thorough review of your medical history, imaging tests (MRI, PET, SPECT), EEG monitoring, and possibly invasive brain monitoring to map the seizure focus accurately.
- Team Consultation: A multidisciplinary team, including a neurosurgeon, neurologist, and epilepsy specialist, will discuss the risks, benefits, and expected outcomes of surgery with you.
During Surgery:
- Surgery is typically performed under general anesthesia, although some procedures (like a temporal lobectomy) may involve awake surgery, especially if brain function needs to be preserved.
- The surgeon will carefully remove or treat the area of the brain responsible for the seizures. The type of surgery will depend on the location of the seizure focus and the patient’s specific needs.
After Surgery:
- Hospital Stay: Recovery times vary, but most patients stay in the hospital for several days to monitor for complications and manage any post-surgical symptoms.
- Recovery and Rehabilitation: After surgery, you may need physical therapy or cognitive therapy to help with recovery. Most patients can return to normal activities after a few months.
- Seizure Control: Many patients experience significant improvements in seizure control, with some becoming seizure-free or having greatly reduced seizures. However, the success of the surgery depends on the location of the seizure focus and other individual factors.
Risks and Considerations
Like any surgery, brain surgery for epilepsy carries some risks. These can include infection, bleeding, memory or cognitive changes, and neurological deficits. Your neurosurgeon will discuss these risks in detail with you during the consultation process to help you make an informed decision about whether surgery is the right choice.
Conclusion
Brain surgery for epilepsy is typically considered when other treatment options have failed to control seizures. If you or a loved one is living with epilepsy and experiencing frequent, debilitating seizures, a consultation with a neurosurgeon can help determine whether surgery may offer relief. At IGEA Brain, Spine, and Orthopedics, we are committed to providing comprehensive care and advanced treatments for patients with epilepsy. Contact us today to learn more about your treatment options.
