Surgical Treatment for Epilepsy: Options and Outcomes

Surgical treatment for epilepsy is usually considered when medication fails to control abnormalities like seizures or lesions. Surgery may be recommended for people with epilepsy who have attacks that originate from a specific part of the brain that can be removed, gaining seizure control and the ability to stop seizures completely for the patient, all without causing any significant neurologic deficits.

Types of Epilepsy Surgery - Neurosurgery Treatment of Epilepsy

1. Temporal Lobectomy: This is the most common surgical procedure for epilepsy, involving a temporal lobe resection or removal. Doctors recommend this procedure for people who have temporal lobe epilepsy, characterized by seizure activity that originates in the brain's temporal lobe.
2. Focal Cortical Resection: This procedure involves the removal of a small area of the brain where the seizures originate. An MRI scan and an EEG identify the area that needs to be removed.
3. Corpus Callosotomy: This procedure involves severing the corpus callosum, the band of nerve fibers that connects the brain's two halves. Neurosurgeons usually perform this procedure for people with severe epilepsy whose seizures originate on both sides of the brain.
4. Vagus Nerve Stimulation (VNS): This is a less invasive procedure that involves the implantation of a device that sends electrical impulses to the vagus nerve in the neck. These impulses help to reduce the seizure frequency and severity of seizures.
5. Deep Brain Stimulation (DBS): This procedure involves the implantation of electrodes into the brain that delivers electrical impulses to specific areas of the brain. Researchers are still studying DBS, a newer and less common treatment for epilepsy.
6. Hemispherectomy: This complex and risky surgery requires a highly skilled neurosurgeon and a team of healthcare professionals. A specialized epilepsy center typically performs the procedure, which requires extensive rehabilitation and ongoing support for the patient. While the surgery can effectively stop seizures in some patients, it also carries significant risks, including the potential for permanent loss of function, such as paralysis or speech difficulties.

It's important to note that not all people with epilepsy are good candidates for surgery. Therefore, a patient should decide to undergo surgery in consultation with a neurologist and a neurosurgeon.

What are the outcomes of surgical treatment for epilepsy?

The outcomes of surgical treatment for epilepsy vary depending on several factors, such as the type and severity of epilepsy, the age and general health of the patient, and the specific surgical procedure performed. However, in general, surgical treatment for epilepsy can be highly effective in reducing or eliminating seizures and in improving the overall quality of life.

According to studies, about two-thirds of people who undergo surgery for epilepsy experience a significant reduction in the frequency and severity of seizures, and many become entirely seizure-free. However, some people may continue to experience seizures after surgery but with reduced frequency or severity.

In addition to reducing seizures, surgical treatment for epilepsy has been found to improve cognitive function, mood, and overall quality of life for many patients. This is especially true for people with frequent and severe seizures that are not well-controlled with medication.

As with all surgical procedures, it's important to remember that there are risks associated. These risks can include bleeding, infection, and damage to surrounding brain tissue, leading to neurological deficits. However, the risks of surgery are generally outweighed by the potential benefits for many people with epilepsy who are good candidates for surgery.

Non-surgical Options for Epilepsy Treatment

As mentioned previously, not all people with epilepsy are good candidates for surgery. The decision to undergo surgery should be made in consultation with a neurologist and a neurosurgeon. However, when medical treatments fail to manage epilepsy-related seizures, brain surgery may be considered. These cases of epilepsy are called "medically refractory" or "drug-resistant epilepsy." They are classified as such when anti-seizure medications (antiepileptic drugs) don't affect the cerebral cortex.

If these non-invasive treatments don't pan out, a patient will schedule a follow-up with their doctor to see if disconnecting brain nerve cell communication to stop the spread of seizures to other areas of the brain is needed. To measure electrical activity, short bursts of electrical stimulation delivered via electrodes placed on the brain after seizure areas have been pinpointed to aid in the mapping of critical brain regions. The brain mapping examination aims to determine whether or not the epileptogenic and functionally essential parts of the brain overlap. In this way, only the affected area must be operated on, lowering the risk of permanent brain damage.

This procedure is called electrical cortical mapping (ECM) or direct cortical stimulation (DCS).

Importance of Brain Mapping in Epilepsy Surgery Planning

Brain mapping examinations, such as electrical cortical mapping (ECM) or direct cortical stimulation (DCS), are essential to the surgical treatment planning process for people with epilepsy. These procedures are used to determine the location of critical brain areas for specific functions, such as language, motor function, or sensation.

During ECM, patients are asked to perform specific tasks or report any sensations they experience. This helps to identify the functional areas of the brain that are being stimulated. For example, suppose the epileptogenic and functionally critical areas overlap. In that case, the neurosurgeon must carefully weigh surgery's potential risks and benefits and work with the patient to determine the best course of action. In some cases, it may be possible to remove or disconnect the epileptogenic tissue while preserving critical brain functions, but in other cases, surgery may not be a viable option. 

The information gathered through brain mapping is essential for guiding treatment decisions and optimizing outcomes for people with epilepsy.

Surgical Treatment and Brain Mapping Offer Hope for Managing Epileptic Seizures

In conclusion, we can say that surgical treatment options for epileptic seizures provide hope for patients whose seizure medication is poorly controlled. Different surgical procedures, such as temporal lobectomy, corpus callosotomy, vagus nerve stimulation, deep brain stimulation, and hemispherectomy, have varying degrees of effectiveness and risks. Still, improved cognitive function, mood, and overall quality of life following surgical treatment for epilepsy are available.