Epilepsy is usually controlled by medical treatment and there are many drugs available in the market based on the type of epilepsy.
About 30 % of patients do not respond to drugs, and in about 1/3rd of these patients, surgery may be indicated to ensure better control of epileptic convulsions. This however involves risks and a long post-operative recovery. Different types of surgical treatments are available including
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.
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.
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.
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
It’s a common brain (neurological) disease characterised by recurrent seizures, which are brief disruptions in normal brain activity that interferes with brain function. Seizures can manifest as full-body convulsions, but there are many kinds – with some types, you might not even notice a seizure at all.
Epilepsy is diagnosed by an electroencephalogram (EEG) test to measure the electrical activity in the brain. Additional imaging tests such as MRIs and/or CT/CAT scans might be done as well. Then, based on the information gathered, a diagnosis of epilepsy might be made.
There are many different kinds split between two categories: generalized and focal (or partial) seizures.
Generalized seizures involve the entire brain – these include absence seizures and tonic-clonic/convulsive seizures, which people often imagine when they think of epilepsy.
Focal seizures, on the other hand, only involve one part of the brain – these include simple partial seizures and complex partial seizures.
Status epilepticus is a seizure that lasts 30 minutes or more, or when seizures repeat without recovery. This can be life threatening and is a medical emergency. If someone has been having a seizure for more than 5 minutes, or a second seizure begins before the person has fully recovered from a previous one you should contact the doctor.
A seizure occurs when there is abnormal activity in the brain and causes a sudden change in awareness, movement or behavior.
There are many possible causes of epilepsy including tumors, strokes and brain damage from illness or injury. It can also be caused if the brain did not develop normally. This is called cortical dysplasia. Many times there seems to be no likely cause for epilepsy – in this case, the cause may be genetic, meaning it runs in the family. Sometimes the cause is not known.
Provoked seizures are caused by something that affects the brain for only a short time. Some examples are:
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