Treatments

Epilepsy surgery is the most effective way to control seizures in patients with drug-resistant focal epilepsy, often leading to improvements in cognition, behaviour, and quality of life. Risks of serious adverse events and deterioration of clinical status can be minimised in carefully selected patients. The effectiveness of surgical treatment depends on epilepsy type, underlying pathology, and accurate localisation of the epileptogenic brain region by various clinical, neuroimaging, and neurophysiological investigations.

Resective Surgery

This is most commonly performed.  The seizure zones are identified on MRI Brain and the affected parts are surgically removed.  Along with this, a brain lesion, a brain lobe, or a portion of a brain lobe may also be removed.  The most common resection performed is a temporal lobectomy. It is considered to be most successful without causing much permanent brain damage.

Multiple Subpial Transection

This is very rarely performed, and only on people suffering from severe, frequent seizures. It involves cutting parts of the brain to prevent the spread of seizures.

Hemispherectomy

Considered the most radical of epilepsy surgeries, the outer layer of one entire side of the brain is removed, and is only done when one entire side is damaged by seizures.  It is usually performed in young children, babies born with brain damage and older children with severe seizures.

Corpus Callosotomy

This procedure does not stop seizures, but only decreases the severity by cutting the nerve fibres between the two sides of your brain.  This is performed on children having bad seizures that start in one half and spread to the other half of the brain.

Implantation of devices in the brain

Devices are surgically implanted. For e.g. in Vagus Nerve Stimulation (VNS), a device that electronically stimulates the vagus nerve (which controls activity between the brain and major internal organs) is implanted under the skin. This reduces seizure activity in some patients with partial seizures. Responsive Neurostimulation Device (RNS), consists of a small neurostimulator implanted within the skull under the scalp. The neurostimulator is connected to electrodes that are placed where the seizures are suspected to originate within the brain or on the surface of the brain. The device detects abnormal electrical activity in the area and delivers electrical stimulation to normalize brain activity before seizure symptoms begin.

Gamma knife/ Stereotactic surgery

Gamma knife is routinely used in brain tumours.  In case of epilepsy, studies have shown that while some patients are immediately free of seizures, for some others, it takes anywhere between 18 to 24 months for the seizures to resolve.  But it must be noted that not all types of epilepsy can be treated with Gamma knife radiosurgery. For more information on Gamma Knife surgery, refer to Gamma knife surgery under Brain tumours.

Pre-surgery work up

Thorough evaluation is done through EEG-Video monitoring and MRI scans to identify the exact site of brain damage causing seizures, and the accessibility is assessed.   This evaluation is usually performed by a team consisting of a neurologist specializing in epilepsy, a neurosurgeon, neuroradiologist, neuropsychologist, and a social worker. A joint decision is taken by the patient and the neurologist after all the risks and benefits of the procedure have been discussed.

Post epilepsy surgery advice

• Hospital stay lasts three to four days after surgery
• Severe pain for a few days after surgery
• Moderate pain and swelling for several weeks
• Total downtime of 3 to 4 months
• To continue anti-seizure drugs after surgery till doctor’s advice to stop.