Epilepsy Surgery

1 What is an Epilepsy Surgery?

A procedure that removes an area of your brain where your seizure originates is called epilepsy surgery.

In order to be a candidate for this procedure, you should have at least tried to anti-seizures drugs without success but it is unlikely that any other anti-epileptic drug will help you if two appropriate drugs have already failed.

This works best if a person has seizures that always originate in the same place in their brains.

2 Reasons for Procedure

Here are the most common reasons to undergo an epilepsy surgery. This procedure can reduce and eliminate your seizure activity.

The epileptic seizures can cause:

  • broken bones or other injuries from falling during a seizure
  • brain damage from prolonged seizures
  • drowning if it occurs while swimming
  • sudden death but rare

Based on the types of seizures you have and where they begin in your brain is the type of epilepsy surgery that your doctor will recommend:

Removing a portion of the brain – this is the most common type which is called resection surgery and the cause of the seizure is the size of a golf ball.

The severing connection between hemispheres – which is called corpus callosotomy which is the network of neural connections between the left and right halves of the brain. This can help in reducing the severity of seizures and is used in children who have severe seizures that start in one hemisphere and spread to the other side.

Removing half of the brain – this is called hemispherectomy which is removing the outer layer of half the brain and is used in children who have seizures because of the damage to one-half of the brain.

In some cases, this will be present at birth or in early infancy.

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3 Potential Risks

The potential risks of epilepsy surgery include:

  • memory problems – because the temporal lobes handle language and memory functions which can lead to difficulties in understanding, speaking and remembering
  • behavioral changes – if the surgery is in frontal lobe this can affect behavior such as concentration or attention, motivation, mood changes, depression and impulse control
  • reduced visual field
  • double vision – this can occur after temporal lobe surgery or occipital lobe surgery

4 Preparing for your Procedure

Your pre-surgical evaluation, if you are preparing for epilepsy surgery includes:

Baseline electroencephalogram (EEG) – this is done by placing electrodes on the scalp to measure the electrical activity that is produced by the brain.

Video EEG – this video will keep monitoring and will record your seizures.

You will have to be admitted to the hospital to undergo this test because your seizure medications have to be temporarily stopped and this test will help in looking for the starting point of the seizure.

CT or MRI of the head – can check if you have scar or lesions in the brain that is the cause of the seizures.

Position emission tomography (PET) and functional MRI – these can detect abnormalities and monitor brain’s activity.

Single-photon emission computerized tomography (SPECT) – this can check the amount of blood flow in different areas of the brain and blood flow is higher in the part of the brain where the seizure originated.

5 What to Expect

Here’s what you can expect before, during, and after your epilepsy surgery.

During the procedure, your hair needs to be clipped short over the section of your skull that will be removed during the operation to avoid infection.

In some cases, patients want to shave their entire head and in some they will just shave the area in a way that other parts of your hair will cover up the bald patch after the surgery but there will be no shaving if the patient is a child.

You will be given a general anesthesia meaning you are unconscious the entire time. Your surgeon will make a small incision in your skull to access the brain.

Throughout the surgery, your blood pressure, heart rate, and oxygen levels will be monitored and you will have an intravenous access.

There will also be an EEG to monitor your brain waves and to check where your seizure starts. This surgery will take up to at least four hours.

The window of bone is replaced and fastened to the remaining skull for healing after the surgery.

After the procedure, you will be monitored in the recovery room or you may need to spend a day in the intensive care unit.

You may be at the hospital for at least three to four days. Most patients will need narcotics to deal with their swollen and painful head and these will resolve in a couple of weeks.

You can also use an ice pack on your head. Your doctor will recommend just relaxing and resting in your house and can return to work after one to three months.

If you do not have complications such as loss of speech or paralysis, you will not need intensive rehabilitation.

6 Procedure Results

If you do not understand your epilepsy surgery results, consult with your doctor. Some seizures can be resistant to medication based on their underlying cause.

For example, nearly 90 percent of people who have temporal lobe seizures will have a significant reduction or a cessation of seizures after the procedure.

To help you improve your chances of remaining seizure-free you will have to continue to use anti-seizure medications and after a year or two your doctor may take you off these medications.

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