Introduction:
Epilepsy is a neurological disorder characterized by abnormal brain activity, which results in seizures of unusual behavior, sensations, and loss of awareness. It can affect anyone. Epilepsy affects both men and women of all races, ethnicities, and ages. The symptoms of a seizure can vary greatly. During a seizure, some people with epilepsy stare blankly for a few seconds, while others twitch their arms or legs repeatedly.
What Are the Risks of Epilepsy Surgery?
Every surgery has risks. Typical surgical risks include the following:
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Anesthesia reaction.
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Bleeding.
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Infection.
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Tissue damage in the brain.
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Healing at the surgical site is delayed.
Aside from these risks, brain surgery can impact vital functions such as memory, speech, vision, and movement. These functions are distributed throughout the brain.
The healthcare providers conduct extensive pre-surgery testing and brain mapping to pinpoint the source of the seizures. The surgical team will do everything possible to ensure that the planned surgery avoids these critical areas.
What Are the Brain Surgeries Available for Epilepsy?
The brain surgeries available for epilepsy are:
Surgical Resection - The neurosurgeon will remove a specific portion of the brain during resection surgery. The neurosurgeon may remove brain tissue near the site of the seizures or the abnormal brain tissue causing the seizures. There are various types of resections, such as:
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Lesionectomy.
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Multilobar resection.
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Lobectomy.
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Hemispherectomy.
Surgical Disconnection - The communication between the brain area causing the seizures and the remaining normal brain tissue is removed during these surgeries.
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Corpus callosotomy.
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Multiple subpial transections.
Laser Interstitial Thermal Therapy - This procedure is less invasive than the other open surgeries.
Neuromodulation - This type of procedure involves implanting devices to improve seizure control. They are:
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Vagus nerve stimulation.
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Deep brain stimulation.
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Responsive neurostimulation.
How to Prepare for Epilepsy Surgery?
If a person is a potential candidate for epilepsy surgery, they should work with a healthcare team at a specialized epilepsy center. Several tests are performed by the medical team to:
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Determine the surgical eligibility.
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Determine the best surgical site.
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Learn in-depth how that part of the brain works.
These are standard procedures for determining the source of abnormal brain activity:
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Electroencephalogram (EEG) at Baseline: Electrodes are placed on the scalp in this test to measure electrical activity produced by the brain when a seizure is not present. This test, which can be performed while asleep or awake, can suggest general brain areas that may be affected.
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Video EEG: Seizures are recorded in real-time using a continuous EEG with video monitoring. This test is performed in a hospital because seizure medications must be reduced or temporarily stopped for seizures to occur.
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Magnetic Resonance Imaging (MRI): MRI employs a magnetic field and radio waves to produce detailed images that allow doctors to identify damaged cells, tumors, and other irregularities that can cause seizures.
What Is the Procedure of Epilepsy Surgery?
First, the healthcare provider will shave the area of the head where the surgery will be performed. Next, the anesthesiologist will administer anesthesia to keep the person asleep during the surgery. Next, the healthcare team will closely monitor the heart rate, blood oxygen level, and blood pressure. During surgery, they may perform an EEG to confirm the precise location or source of the seizures. A person will not experience any discomfort during this stage of the procedure. After the brain mapping, the person will be put back to sleep. Next, the neurosurgeon will use the appropriate surgical approach to treat the area of brain tissue where the seizures occur. They will then bandage the head and close the skin covering the skull.
What Is the Procedure After Epilepsy?
After epilepsy surgery, there will be scalp and face swelling and headaches. The person will be given medications to alleviate these symptoms. Symptoms subside after a few weeks. Most people have a one-day intensive care stay followed by a three to four day hospital stay. One will need to take anti-seizure medication after the surgery. The medications protect the brain while it heals and reduce the chances of having seizures later on. A person will need to drink plenty of water, rest, and gradually resume normal daily activities in four to six weeks. A person can return to work or school in one to three months. If a person has not had any seizures in a year or more, the doctor may gradually reduce the medication dosage and eventually discontinue it.
What Are the Results of Epilepsy Surgery?
The outcomes of epilepsy surgery vary depending on the type of procedure carried out. Seizure control with medication is the expected result. The most common and well-understood procedure, temporal lobe resection, results in seizure-free outcomes for roughly two-thirds of people.
According to studies, if a person takes seizure medication and does not have a seizure in the first year following temporal lobe surgery, the chances of being seizure-free at two years are 87 percent to 90 percent. If there are no seizures in the first two years, the chances of remaining seizure-free are 95 percent after five years and 82 percent after ten years. If there have been no seizures for the past year, the healthcare provider may reduce or discontinue the anti-seizure medication.
Conclusion
If one has epilepsy and medications have failed to control seizures, surgery may be an option. There are now numerous epilepsy surgeries available. The location of the seizures in the brain is important in determining which surgery is best.
