Surgery: Can this be a cure for Epilepsy?
CASE 6: continued...
While the efficacy of this sort of approach is not traditionally as satisfying as focal epilepsy surgery, it is a useful tool in certain populations of children with epilepsy. In general, about a third of the patients who have a vagus nerve stimulator placed experience a significant reduction in seizure frequency and severity, and medication regimens can be significantly decreased. The natural appeal of such an approach, as any parent can imagine, is that the procedure is reversible: the stimulator (but not the wires) can be removed if the treatment is not effective, with no significant long term consequences.
Optimizing targets and parameters for neurostimulation to control epilepsy will be the focus of our research efforts to offer even safer and more attractive options to treat epilepsy in the future.•
In the previous case, a child underwent a focal resection before undergoing a corpus callosotomy. In this case, of a 19-year-old with autism and severe developmental delays, the procedures were reversed. She was initially diagnosed with infantile spasms as a baby. (Infantile spasms are a severe form of epilepsy occurring in infants 3-9 months old.) She went on to fail many different medications and became increasingly distant, with loss of her limited language and previously acquired skills. After she was accepted in a residential setting, she began to experience disabling drop attacks, causing her to wear a helmet. After a video EEG and MRI, it was determined that a corpus callosotomy was indicated. She underwent the procedure and her drop attacks stopped but she began to exhibit partial or focal seizures, with her head turning to the right, speech arrest and staring. She was reevaluated and the video EEG showed focal onset of her complex partial seizures. Grids and strips were implanted on the right side of her brain, seizure onset and epilpetogenic zone were delineated, and a right frontal disconnection was performed. Although she underwent four surgeries in total (including placement of a vagal nerve stimulator) and remains on medication, the family and the personnel at her school report increased language, better eye contact and a happier young woman, with a big decrease in seizure frequency and severity.
As with all surgical procedures, epilepsy surgery carries with it a small risk of infection as well as bleeding. The length of recovery varies from person to person but most children and young people recover quickly, spending 1-3 weeks in the hospital and resuming their usual activities within a month of hospital discharge. Again, the most important thing to remember is that epilepsy surgery is a safe and efficacious treatment for refractory patients. It is appropriate even in the setting of severe developmental delays, widespread areas of abnormality and neurocutaneous syndromes. Results must be measured in improvement in quality of life and not just in seizure freedom. The courageous children and parents who embark upon this strategy in search of a better quality of life, independence, and freedom from disabling seizures and their medications must be cared for by a team of trained and experienced professionals, with careful deliberation and testing both before, during, and after the procedure.