Surgery may provide relief from epileptic seizures when medications aren't working.
Epilepsy surgery is a procedure that removes an area of the brain where seizures occur.
Epilepsy surgery is most effective when seizures always occur in a single location in the brain. Epilepsy surgery is not the first line of treatment. But it might be an option when at least two anti-seizure medicines have failed to control seizures.
You might need several tests before surgery to find out whether epilepsy surgery is an option and what type of surgery to do.
Epilepsy surgery may be an option when medicines don't control seizures. This is a condition known as medically refractory epilepsy or drug-resistant epilepsy. Epilepsy surgery is done to stop seizures or limit their severity. Surgery also is done to lessen seizure-related deaths, decrease the use of anti-seizure medications and decrease the possible side effects of the medicines.
Poorly controlled epilepsy can result in a number of complications and health risks, including:
Epileptic seizures result from irregular activity of brain cells called neurons. The type of surgery needed depends on the location of the neurons that start the seizure and the age of the person having the surgery. Types of surgery include:
The temporal lobe is located along each side of the brain.
Different areas of the brain control different functions. The risks vary depending on the surgical site and the type of surgery. The health care team explains the specific risks of the procedure, as well as the ways they can reduce the risk of complications. Risks may include:
If someone is a possible candidate for epilepsy surgery, that person works with a health care team at a specialized epilepsy center. The health care team does several tests to:
Some of these tests are done as outpatient procedures, while others require a hospital stay.
These procedures are standard tests used to identify the source of irregular brain activity.
The surgical team may order additional tests to localize the source of seizures and to characterize the nature of the unusual activity. These tests may include:
Depending on the surgical site, the health care team may recommend tests to determine the precise areas of the brain that control language, sensation, motor skills and other important functions. This information helps the surgeon preserve function to the greatest extent possible when removing or altering a site in the brain.
The tests may include the following:
Additionally, testing is usually recommended to measure verbal and nonverbal learning skills and memory function. These tests may provide additional insight into the area of the brain affected by seizures, as well as a baseline for measuring function after surgery.
This example shows SPECT scans taken during and between seizures. The differences represent areas where blood flow increased during the seizure. Once identified, that location is fitted onto an MRI scan of the brain.
To avoid infection, hair is clipped short or shaved over the section of the skull that will be removed during the operation. A small, flexible tube is placed within a vein to deliver IV fluids, anesthetics or other medicines during the surgery.
Heart rate, blood pressure and oxygen levels are monitored throughout the surgery. An EEG monitor may record brain waves during the operation to better localize the part of the brain where seizures start.
Epilepsy surgery is usually done using general anesthesia. The person is unconscious during the procedure. In rare circumstances, the surgeon may awaken the person during part of the operation to help the team determine which parts of the brain control language and movement. In such cases, medicine is used to control pain.
The surgeon creates a relatively small window in the skull, depending on the type of surgery. After surgery, the bone is replaced and fastened to the remaining skull for healing.
The person is placed in a special recovery area to be monitored carefully after awakening from anesthesia. The person is usually placed in the intensive care unit the first night after surgery. The total hospital stay for most epilepsy surgeries is usually about three or four days.
After awakening, the head will be swollen and painful. Most people need to take pain medicine for at least the first few days. An ice pack on the head also may help. Most postoperative swelling and pain resolve within several weeks.
Most people are not able to return to work or school for about 1 to 3 months. Rest and relaxation are needed for the first few weeks after epilepsy surgery and then physical activity can be increased.
It's unlikely that intensive rehabilitation will be needed as long as the surgery was completed without complications such as a stroke or loss of speech.
The outcomes of epilepsy surgery vary depending on the type of surgery performed. The expected outcome is seizure control with medication.
The most common and best-understood procedure — resection of tissue in the temporal lobe — results in seizure-free outcomes for about two-thirds of people. Studies suggest that if a person takes seizure medicine and does not have a seizure in the first year after temporal lobe surgery, the likelihood of being seizure-free at two years is 87% to 90%. If there are no seizures in two years, the likelihood of being seizure-free is 95% at five years and 82% at 10 years.
If there are no seizures for at least one year, the health care provider may consider decreasing the anti-seizure medicine and eventually discontinuing it entirely. Most people who do experience a seizure after going off medicine are able to obtain seizure control by resuming medicine.