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 is considered when at least two anti-seizure medications have failed to control seizures.
A number of pre-surgical tests are necessary to determine whether you're eligible for epilepsy surgery and how the procedure is performed.
Epilepsy surgery may be an option when medications do not control seizures, a condition known as medically refractory epilepsy or drug-resistant epilepsy. The goal of epilepsy surgery is to stop seizures or limit their severity with or without the use of medications.
Poorly controlled epilepsy can result in a number of complications and health risks, including the following:
Epileptic seizures result from abnormal activity of certain brain cells (neurons). The type of surgery depends on the location of the neurons that start the seizure and the age of the patient. Types of surgery include the following:
The temporal lobe is located along the sides of your brain.
Your brain is divided into two halves, called hemispheres.
Different areas of the brain control different functions. Therefore, risks vary depending on the surgical site and the type of surgery. Your surgical team will help you understand the specific risks of your procedure, as well as the strategies the team will use to reduce the risk of complications. Risks may include the following:
If you're a possible candidate for epilepsy surgery, you will work with a medical team at a specialized epilepsy center. Your team will conduct several tests to determine your eligibility for surgery, identify the appropriate surgical site and understand in detail how that particular region of your brain functions. Some of these tests are performed as outpatient procedures, while others require a hospital stay.
The following procedures are standard tests used to identify the source of abnormal brain activity.
Your surgical team may order additional tests to localize the source of seizures and to characterize the nature of the abnormal activity. These tests may include:
Depending on the surgical site, your team may recommend tests to determine the precise areas of the brain that control language, sensory functions, motor skills or other critical functions. This information helps your surgeon preserve function to the greatest extent possible when removing or altering a site in your brain.
The test 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, your hair will need to be clipped short or shaved over the section of your skull that will be removed during the operation. You will have a small, flexible tube placed within a vein (intravenous access) to deliver fluids, anesthetic drugs or other medications during the surgery.
Your heart rate, blood pressure and oxygen levels will be monitored throughout the surgery. An EEG monitor also may be recording your brain waves during the operation to better localize the part of your brain where your seizures start.
Epilepsy surgery is usually performed during general anesthesia, and you'll be unconscious during the procedure. In rare circumstances, your surgeon may awaken you during part of the operation to help the team determine which parts of your brain control language and movement. In such cases, you would receive medication to control pain.
The surgeon creates a relatively small window in the skull, depending on the type of surgery. After surgery the window of bone is replaced and fastened to the remaining skull for healing.
You'll be in a special recovery area to be monitored carefully as you awaken after the anesthesia. You may need to spend the first night after surgery in an intensive care unit. The total hospital stay for most epilepsy surgeries is usually about three or four days.
When you awaken, your head will be swollen and painful. Most people need narcotics for the pain for at least the first few days. An ice pack on your head also may help. Most postoperative swelling and pain resolve within several weeks.
You'll probably not be able to return to work or school for approximately one to three months. You should rest and relax the first few weeks after epilepsy surgery and then gradually increase your activity level.
It's unlikely that you would need intensive rehabilitation 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 you do not have a seizure in the first year after temporal lobe surgery — with medication — the likelihood of being seizure-free at two years is 87% to 90%. If you have not had a seizure in two years, the likelihood of being seizure-free is 95% at five years and 82% at 10 years.
If you remain seizure-free for at least one year, your doctor may consider discontinuing your anti-seizure medication and eventually taking you off of the drugs entirely. Most people who do experience a seizure after going off medication are able to experience seizure control by resuming drug treatment.