Surgery for Epilepsy

Epilepsy is a disorder affecting the brain that results in seizures. The brain is responsible for all important bodily functions. It works by sending adequate messages in response to stimuli and helps in interpreting and perceiving signals received by other organs of the body. Epilepsy can cause certain sections of the brain to send abnormal or incorrect messages resulting in strange sensations, muscle spasms, convulsions and loss of consciousness.

Epilepsy can have many possible causes including illness leading to brain damage, abnormal growths in the brain or genetics. Epilepsy can also develop as a result of brain damage from other disorders including brain tumors, alcoholism, Alzheimer's disease, strokes, and heart attacks. Epilepsy is also associated with a variety of developmental and metabolic disorders.

Surgery is a treatment alternative for people whose seizures are not successfully controlled by anti-epileptic drugs. The treatment has been used for many years, and its usage has dramatically increased as of late.  It is considered one of the most effective ways in managing seizures.

Most of the patients are successfully treated with medication. Surgery is an option for patients who have frequent disabling seizures and medication does not show the desired effects. Some patients are not able to stand the severe side-effects of medication that can affect normal life. The goal of the surgery is to remove the area of the brain that is causing the seizures. In cases where the affected area controls vital functions of the body, surgery works by inhibiting the nerve pathways that seizure takes through your brain. In some other cases, a device is implanted into the brain to treat epilepsy.

Most of the time, surgery is performed when tests have determined that the seizures are originating from a small, well-defined region of the brain that does not impede vital functions such as language, speech, motor function, hearing or vision. During surgery, the part of the brain causing the seizures will be removed. People with serious medical problems, like cancer or heart disease, are not considered for surgery.

Below are other types of surgery which are performed in patients with epilepsy:

• Resective surgery- This is the most common type of surgery performed for the treatment of epilepsy. In this surgery, the part of the brain that causes seizures is removed. This area is about the size of a golf ball. The human brain comprises of four lobes; if one or more lobes is causing the seizures, the entire lobe or in some cases, a portion of it is removed.

     Abnormal growths or brain lesions may also be removed.

• Multiple subpial resections- Surgery is performed while the patient is awake. This procedure is implicated when seizures originate from the part of the brain that controls speech, movement, and other functions. The surgeon will ask questions and monitor the patient during surgery.

 

        Several cuts in are made when seizures originate from an area of the brain    that cannot be removed. This procedure is intended to prevent seizures from spreading to other regions of the brain.

 

• Temporal lobectomy- The surgical procedure which removes a portion of the temporal lobe that’s causing seizures. Temporal lobectomy is the most common type of surgery and is the most successful option for epilepsy.
• Corpus callosotomy- The corpus callosum divides the brain into two hemispheres. It is a specialized connective tissue that allows communication between the two hemispheres. During corpus callosotomy, the corpus callosum will be separated, either partially or completely, reducing or preventing communication between the two hemispheres.
• Hemispherectomy- In this surgery, the affected portions of the brain’s hemispheres will be removed. This surgical procedure is often implicated in children who have Rasmussen’s encephalitis epilepsy, a condition which can result in serious damage of the brain’s hemispheres. Hemispherectomy is considered the most radical form of surgery for epilepsy.
• Vagus nerve stimulation- A surgical procedure designed to suppress seizures. It involves inserting a small machine into the body with wires connected to the vagus nerve. The machine will then periodically excite the nerve to stimulate the brain.
• Responsive neurostimulation device (RNS): an electrode is implanted into the skull or the part of the brain that is causing the seizures. It is connected to the neurotransmitter placed under the skin of the shoulder or lower in the stomach by thin extension wires... The device detects abnormal electrical activity in the area and sends an electric current. It can stop the process that leads to a seizure.

 

What are the risks of brain surgery?

Every surgery has its own risks. Brain surgery is no exception. Risks include:

• Stroke
• Problems with speech
• Paralysis
• Infection
• Loss of motor skills
• Loss of vision
• More episodes of seizures
•  

No matter what type of surgical procedure performed, patients will still need medications. These medications can help prevent seizures after surgery. Normally, medications are reduced after surgery. Brain surgery may improve the person's quality of life.

Talk with your doctor before undergoing surgery. Understanding the advantages and disadvantages of each treatment option will aid you in dealing with epilepsy.

As with any surgery, the exact outcome of the surgery is known only after the procedure. But, after the pre-surgery tests, your doctor will be in a good position to judge the overall picture. The decision to opt for surgery would come from your doctor only if the benefits outweigh the risks involved. The following problems which may result from these specific types of surgery:

Temporal lobe surgery - The temporal lobes of the brain control memory and language. Any surgery in this part of the brain can cause problems in remembering, understanding and speaking. However, in some instances, surgery can result in better memory.

Corpus callosotomy – since the areas of the brain have not been removed completely the seizure will continue but they will be less severe.

Hemispherectomy – this kind of surgery can affect one side of the body in some patients and they may not be able to carry out normal functions from this part. In some other instances, the vision of the patient may get affected.