Surgery for Epilepsy Treatment

An increasing number of people are undergoing surgery for epilepsy. Brain surgery can be a very effective treatment method for epilepsy, particularly when multiple seizure medications have failed to control the individual's seizures.

What Does Surgery for Epilepsy Involve?

The purpose of brain surgery is to remove the area of the brain where the seizures are originating. This is called the epilepsy "focus." If the area can't be removed, the surgeon will try to isolate the area by cutting off neural pathways to other areas of the brain. Types of brain surgery for epilepsy include:

• Corpus callosotomy: Cutting the neural connections between the brain's two hemispheres
• Hemispherectomy: Removing the outer layer of the damaged half of the brain
• Sub-pial resection: Making small cuts in the brain to prevent the spread of seizures
• Temporal lobectomy: Removal of part of the temporal lobe (this is the most common type of brain surgery for epilepsy).

When is Surgery for Epilepsy Considered?

Prior to brain surgery, doctors will conduct extensive neuropsychological tests to determine the exact location of the epilepsy focus in the brain, and the likelihood that surgery would safely and successfully remove it. There are a number of factors to consider and, as a result, only a relatively small number of people are candidates for brain surgery. Epilepsy patients with "medically refractory seizures"—that is, seizures that have not been controlled after trying two or more seizure medications—may be recommended for surgery.

Other conditions for surgery include when:

• Seizures negatively affect the individual's quality of life
• The operating on this area would not impair the individual's other neurological functions
• There is a clear epilepsy focus.

Benefits of Surgery for Epilepsy

Surgery for epilepsy is only considered if the individual is suffering severely from epilepsy, and surgery is likely to ease that suffering. Some of the primary benefits of brain surgery include:

• Early surgery may prevent seizure-related brain damage in children
• Most people's seizures are significantly reduced or cease completely as a result of surgery
• The majority of patients recover quickly.

Risks of Surgery for Epilepsy

Surgery for epilepsy is only ever conducted if the benefits will outweigh the risks. However, brain surgery always involves some risks, including:

• The brain could be harmed during surgery which could affect cognitive functions (thought processes)
• There is no guarantee that the surgery will reduce the frequency of seizures.

Epilepsy and Surgery: Long-Term Outlook

Though the vast majority of people who undergo surgery for epilepsy notice an improvement in the frequency and/or severity of their seizures, many people continue to take medication for one to two years after their brain surgery. If they don't have any more seizures, their doctor will slowly discontinue their medication. After this, their chances of living seizure-free are very high.

Resources

Dekker, P.A. (2002). Epilepsy: A manual for medical and clinical officers in Africa. Retrieved March 10, 2010, from http://www.who.int/mental_health/media/en/639.pdf

Donner, E. J.