If you or a loved one has been struggling with epilepsy that doesn’t respond to medications, surgery may be a viable option. Approximately one-third of people with epilepsy experience drug-resistant seizures, and many find that the side effects of antiepileptic drugs are intolerable. Dr. Dario Englot, the neurosurgical director of epilepsy at Vanderbilt Health, highlights the increasing range of surgical options available today, including minimally invasive techniques.
Understanding Epilepsy and Its Treatments
Epileptic seizures occur due to irregular activity in brain cells, known as neurons. When medications fail, surgical intervention may be considered. Research published in JAMA indicates that 34% to 74% of individuals who undergo surgery for medically refractory seizures may become seizure-free.
Types of Surgical Interventions
The appropriate surgical procedure often depends on the location of seizure onset in the brain and the patient’s age. Here are some common surgical options:
- Craniotomy: This is the most frequently performed procedure for epilepsy. During a craniotomy, a portion of the skull is removed to access the brain. The surgeon can perform a focal resection, removing the part of the brain causing the seizures. This procedure generally requires a hospital stay of several days and a recovery period of about a month, but it boasts a high success rate.
- Corpus Callosotomy: This surgery involves the complete or partial removal of the corpus callosum, the structure connecting the two hemispheres of the brain. It is often performed on children whose seizures spread from one side of the brain to the other.
- Hemispherectomy: This procedure involves the removal of one hemisphere of the brain and is typically reserved for children with severe epilepsy originating from multiple sites in one hemisphere.
- Functional Hemispherectomy: This option removes the connecting nerves of one hemisphere without removing actual brain tissue, primarily used in pediatric patients.
New Diagnostic Procedures
Advancements in diagnostic technology now allow for the identification of seizure origins through less invasive means. For many patients, imaging and electroencephalography (EEG) can pinpoint seizure activity without needing surgery. However, some patients require stereotactic electroencephalography, where electrodes are inserted directly into the brain through small incisions to gather more precise data.
Treatment Options Post-Diagnosis
Once the seizure origin is identified, treatment options fall into two primary categories: ablation and brain stimulation.
- Ablation: This technique destroys the area of the brain where seizures begin. In stereotactic laser ablation, a laser probe is inserted through a small opening in the skull while the patient is under anesthesia. The surgeon can observe the process via MRI, ensuring they target the correct area without damaging surrounding tissue.
- Brain Stimulation: This category includes two FDA-approved techniques—responsive neurostimulation and deep brain stimulation. Responsive neurostimulation involves implanting electrodes in seizure-prone areas and a device that provides electrical stimulation when seizures are imminent, often without the patient even noticing. Deep brain stimulation stimulates the thalamus, an area that connects with nearly all brain regions, which can be beneficial for patients with seizures from multiple sources.
Vagus Nerve Stimulation (VNS)
For those who may not require or desire brain surgery, vagus nerve stimulation is an alternative. An electrode is implanted in the neck, connected to a device in the chest that stimulates the vagus nerve. This method has been used for about 20 years and can help decrease seizure frequency without needing to localize the seizure source.
Conclusion
If you’re exploring options for epilepsy treatment, surgery may be an effective solution, especially if medications have proven ineffective. With advancements in surgical techniques and diagnostic methods, there is hope for those with drug-resistant epilepsy. Consult with an epilepsy specialist to discuss the best options tailored to your unique situation.
