Medications can control seizures in most people with epilepsy, but they don’t work for everyone. About 30% of people taking the drugs can’t tolerate the side effects. In some cases, brain surgery may be an option.
An operation on the brain can control seizures and improve your quality of life. Surgery has three main goals:
Seizures are the basic indicator of epilepsy. They vary widely:
Staring straight ahead, repetitive swallowing, and lapsing into complete immobility for a few seconds characterize absence (petit mal) seizures, which can recur many times in a day.
Tonic/clonic (grand mal) seizures, which usually last several minutes, typically begin with a loss of consciousness and a fall, followed by rigidity, then jerking motions and incontinence of urine. After the seizure ends, there is usually a period...
Remove the area of the brain that causes seizures.
Disrupt the nerve pathways that seizure impulses take through your brain.
Implant a device to treat epilepsy.
Who Gets Epilepsy Surgery?
Surgery is only an option if:
Your doctor can clearly identify the area of the brain where the seizures start, called the seizure focus.
The area to be removed doesn’t control a critical function like language, sensation, or movement.
If you pass that set of criteria, it works best when:
Your seizures are disabling.
Medication doesn’t control your seizures.
Drug side effects are severe and affect your quality of life.
People with other serious medical problems, like cancer or heart disease, usually aren’t considered for this treatment.
What Are the Options?
The type of surgery used depends on the type of seizures you have and where in your brain they start.
Lobe resection: The largest part of your brain, the cerebrum, is divided into four paired sections called lobes -- the frontal, parietal, occipital, and temporal lobes. Temporal lobe epilepsy, in which the seizure focus is located within your temporal lobe, is the most common type in teens and adults. In a temporal lobe resection, brain tissue in this area is cut away to remove the seizure focus. Extratemporal resection involves removing brain tissue from areas outside of the temporal lobe.
Lesionectomy:This surgery removes brain lesions -- areas of injury or defect like a tumor or malformed blood vessel -- that cause seizures. Seizures usually stop once the lesion is removed.
Corpus callosotomy:The corpus callosum is a band of nerve fibers connecting the two halves (called hemispheres) of your brain. In this operation, which is sometimes called split-brain surgery, your doctor cuts the corpus callosum. This stops communication between the hemispheres and prevents the spread of seizures from one side of your brain to the other. It works best for people with extreme forms of uncontrollable epilepsy who have intense seizures that can lead to violent falls and serious injury.
Functional hemispherectomy:In a hemispherectomy, the doctor removes an entire hemisphere -- or half of your brain. In a functional hemispherectomy, the doctor leaves the hemisphere in place but disconnects it from the rest of your brain. He only removes a limited area of brain tissue. This surgery is mostly for children younger than 13 who have one hemisphere that doesn’t work like it should.
Multiple subpial transection (MST):This procedure can help control seizures that begin in areas of your brain that can’t be safely removed. The surgeon makes a series of shallow cuts (he’ll call them transections) in your brain tissue. These cuts interrupt the flow of seizure impulses but don’t disturb normal brain activity. That leaves your abilities intact.
Vagus nerve stimulation (VNS) : A device implanted under your skin sends an electronic jolt to the vagus nerve, which controls activity between your brain and major internal organs. It lowers seizure activity in some people with partial seizures.
Responsive neurostimulation device (RNS): Doctors implant a small neurostimulator in your skull, just under your scalp. They link it to one or two wires (called electrodes) that they place either in the part of your brain where the seizures start or on your brain’s surface. The device detects abnormal electrical activity in the area and sends an electric current. It can stop the process that leads to a seizure.