Epilepsy and Seizure Disorders Surgical Treatments
Some patients who do not respond to anti-epileptic medications may benefit from epilepsy surgery-50 to 80 percent of patients who are suitable candidates for surgery are seizure-free after surgery and many patients who aren't seizure free enjoy substantial reduction in their seizures following surgery.
While surgery may seem like a radical step for the treatment of epilepsy, it has been an accepted form of treatment for over 50 years.
Proper patient selection and a thorough pre-surgical evaluation are the cornerstones of surgical success. The pre-surgical evaluation is a relatively lengthy process, which may take several months.
While surgery has risks, studies have consistently shown that the benefits of reducing or curing seizures outweigh the risks of surgery. Many new advances in epilepsy surgery have become available in the last few years allowing minimally invasive approaches to treating epilepsy as well as neurostimulation-based treatment options which don't require the damage or removal of any brain tissue in order to control seizures.
The team at the Northwestern Comprehensive Epilepsy Center can discuss these treatment options with you in more detail if you may be a candidate for epilepsy surgery.
A pre-surgical evaluation can determine the seizure's location and whether it may be surgically treated. The best candidates for epilepsy surgery are people whose seizures originate from a single location in the brain and the region of the brain can be safely removed without causing significant disability. Conditions that often fall into this category include:
- Mesial temporal sclerosis or hippocampal sclerosis (disorder seen in 75 percent of epilepsy surgery patients)
- Cortical dysplasia (congenital abnormality)
- Other congenital anomalies of brain development
- Cavernous angioma (benign vascular tumors)
- Other brain tumors
- Brain trauma
Types of surgical treatments for epilepsy:
- Temporal lobectomy or cortical resection
- Vagus Nerve Stimulation (VNS)
- Corpus callosotomy
Epilepsy surgery candidate evaluation
The following diagnostic tests may be included in the pre-surgical evaluation:
- Electroencephalography (EEG) records the electrical activity in the brain.
- Inpatient video EEG monitoring precisely correlates the clinical and electrical features of a seizure.
- Epilepsy-protocol MRI helps identify subtle structural abnormalities in the brain.
- Ictal single-photon emission computed tomography (Ictal SPECT) scan identifies areas of greatest blood flow during a seizure.
- Positron emission tomography (PET) scan shows the brain's use of oxygen or sugar (glucose).
- Neuropsychology testing measures your memory, language and cognition
- Intracranial electrodes and invasive EEG monitoring is used if all of the presurgical studies do not sufficiently show the origin of your seizures.