Neurosurgeon Questions Seizures

Is there a surgery to treat symptoms of seizures?

My nephew, my sister's son, is 4 years old and is experiencing seizures. I am concerned about their family. Is there usually a surgery to treat this or how does that work?

6 Answers

The way it usually works is for the seizure work up to try to identify the electrical source of the seizure. This is initiated by the treating neurologist and can be quite extensive if the seizures are not controlled by medications alone.
There are a number of types of surgery for seizures, and these can range from a small resection of brain or creating a lesion at the source of the seizures, to a complete hemispherectomy for very serious intractable seizures.
Yes, there is a surgical treatment for certain kinds of seizures. He needs to see the epilepsy center where both neurologists and neurosurgeons who are experts in seizures work as a team.
Seizures at this age can happen for many different reasons, so first you need to find out what is causes them to occur. There are some seizure types that kids grow out of, yet others that requires medical and/or surgical intervention. MRI, CT, EEG, Labs, Lumbar Punctures are some examples of studies included in the work up.. hope that helps!
Epilepsy (recurring seizures) can be treated with surgery in selected cases. This is usually predicated on medications not working and a subsequent detailed investigation with regard to whether there is a cause for seizures and where they are coming from. This involves MRI scans (to look for abnormal areas), extended hospital admissions to record video and EEG (brain waves) to see if seizures start in one location, other tests such as MEG (magnetoencephalography), PET (Positron emission tomography.... radioctive tracer to look at brain activity), SPECT (single photon emission tomography) and other tests. All this requires a specialized team for surgical treatment of epilepsy including specially trained neurologists, neurosurgeons, neuropsychologists, nurses, EEG technicians etc. In young children this should be in a specialized children's hospital.
Seizures starting in a localized abnormal area can be helped by removing that area surgically. "Generalized" seizures that start all over cannot be helped by surgical removal of brain areas but there are options for disconnection of stimulation of either brain areas of the vagus nerve in the neck by implanted pacemakers.
In summary, most seizures are not treated by surgery because medications work. When medications are not working optimally, surgery can be a consideration in some if the extensive work-up leads to reasonable surgical options.... so only a minority for surgery overall.
There are a number of different surgical procedures to treat seizures depending on the origin of the attacks. A workup at a Comprehensive Epilepsy Center is required to determine the type of seizures and the location within the brain in order to determine if surgery is indicated and if so, what surgical procedure would be best for that particular type of seizures. Not all seizure types can be treated surgically and surgery is usually used only in patients who have "failed" medical treatment.