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Reviewed by

Dr. Gajendra Singh Sandhu

Consultant - Neurosurgery

Manipal Hospitals, Ghaziabad

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What is Epilepsy Surgery?

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Epilepsy surgery is a specialized medical procedure aimed at treating epilepsy by removing or altering the part of the brain responsible for seizures. This type of surgery is often considered when medications fail to control seizures effectively. For many patients, epilepsy surgery can significantly improve their quality of life by reducing or eliminating seizures. This blog will explore the key aspects of epilepsy surgery, including its what is epilepsy, types of epilepsy, benefits, risks, and what to expect during the treatment.

Understanding Epilepsy

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. These seizures are caused by abnormal electrical activity in the brain. While medications can control seizures in many patients, about one-third of individuals with epilepsy do not respond adequately to drug therapy. For these patients, epilepsy surgery may be a viable option.

Purpose of Epilepsy Surgery

The primary goal of epilepsy surgery is to reduce or eliminate seizures. This is achieved by removing or altering the part of the brain where seizures originate. By doing so, the surgery aims to improve the patient’s quality of life, allowing them to engage in daily activities without the constant fear of seizures.

Types of Epilepsy Surgery

There are several types of epilepsy surgery, each tailored to the specific needs of the patient. The choice of surgery depends on the location of the seizure focus, the type of seizures, and the overall health of the patient. Here are some common types of epilepsy surgery:

Resective Surgery: This is the most common type of epilepsy surgery. It involves removing the part of the brain where seizures originate. The most common resective surgery is temporal lobectomy, which targets the temporal lobe, a common site for seizure activity.
Laser Interstitial Thermal Therapy (LITT): This minimally invasive procedure uses a laser to destroy the seizure focus. It is guided by MRI to ensure precision and minimize damage to surrounding brain tissue.
Corpus Callosotomy: This surgery involves cutting the corpus callosum, the bundle of nerve fibers connecting the two hemispheres of the brain. It is typically used for patients with severe, generalized seizures that do not respond to other treatments.
Multiple Subpial Transection (MST): This procedure involves making small cuts in the brain tissue to interrupt the spread of seizure activity. It is often used when the seizure focus is in an area that cannot be safely removed.
Vagus Nerve Stimulation (VNS): While not a traditional brain surgery, VNS involves implanting a device that stimulates the vagus nerve to reduce seizure frequency. It is often used in conjunction with other treatments.

Consult our specialists at Manipal Hospitals to explore the benefits of epilepsy surgery. Take the first step towards a seizure-free life and book your consultation today!

Benefits of Epilepsy Surgery

Epilepsy surgery offers several potential benefits for patients who do not respond to medications:

Here are some data references supporting the benefits of epilepsy surgery:

Seizure Control: A systematic review and meta-analysis found that the long-term seizure-free rate following temporal lobe resective surgery was around 66%. This significant reduction in seizure frequency can greatly improve the quality of life for patients.
Reduced Medication Dependence: Successful epilepsy surgery can lead to a reduction in the need for anti-seizure medications. This is beneficial as these medications often come with side effects that can impact overall health and well-being.
Improved Cognitive Function: Studies have shown that reducing or eliminating seizures through surgery can lead to improvements in cognitive function, memory, and attention. This is particularly important for patients whose cognitive abilities are affected by frequent seizures.
Enhanced Quality of Life: With fewer or no seizures, patients can engage in activities they may have previously avoided, such as driving, working, and participating in social events. This enhancement in quality of life is a significant benefit of successful epilepsy surgery.

Step	Description	Types of Surgery
1. Pre-Surgical Evaluation	Comprehensive assessment including medical history, neurological exams, and imaging studies.	Resective Surgery: Removes the part of the brain where seizures originate. Examples: Lobectomy, Lesionectomy.
2. Video-EEG Monitoring	Continuous EEG and video recording to pinpoint the seizure focus.	Laser Interstitial Thermal Therapy (LITT): Uses a laser to destroy seizure-causing brain tissue.
3. Neuropsychological Testing	Assesses cognitive function to understand the impact of seizures and potential surgery.	Deep Brain Stimulation (DBS): Implants electrodes to send electrical impulses to the brain.
4. Wada Test	Evaluates language and memory functions of each hemisphere.	Corpus Callosotomy: Severs the corpus callosum to prevent seizure spread between hemispheres.
5. Surgical Planning	The multidisciplinary team reviews all data to plan the surgery.	Hemispherectomy: Removes or disconnects one hemisphere of the brain.
6. Surgery	The chosen surgical procedure is performed.	Multiple Subpial Transections (MST): Cuts nerve pathways to prevent seizure spread without removing brain tissue.
7. Post-Surgical Care	Monitoring and managing recovery, including follow-up appointments and rehabilitation.	Vagus Nerve Stimulation (VNS): Uses a device to stimulate the vagus nerve to reduce seizures.

Risks and Considerations

As with any surgical procedure, epilepsy surgery carries risks. Patients need to discuss these risks with their healthcare team to make an informed decision. Some potential risks include:

Infection: As with any surgery, there is a risk of infection at the surgical site.
Bleeding: There is a risk of bleeding during or after the surgery, which can lead to complications.
Neurological Deficits: Depending on the location of the surgery, there is a risk of neurological deficits, such as weakness, sensory changes, or speech difficulties.
Incomplete Seizure Control: In some cases, surgery may not completely eliminate seizures, and patients may still require medication or additional treatments.
Anesthesia Risks: As with any surgery requiring anaesthesia, there are risks associated with the use of anaesthesia.

Epilepsy Surgery Process

The process of epilepsy surgery involves several steps, from initial evaluation to post-operative care. Here is an overview of what patients can expect:

Pre-Surgical Evaluation: This includes a comprehensive assessment to determine if the patient is a candidate for surgery. It involves various tests, such as MRI, EEG, and neuropsychological evaluations, to pinpoint the seizure focus and assess brain function.
Surgical Planning: Based on the evaluation results, the surgical team will plan the procedure, considering the type of surgery and the specific needs of the patient.
Surgery: The surgery is performed under general anaesthesia. The duration of the surgery depends on the type and complexity of the procedure.
Post-Operative Care: After the surgery, patients are monitored in the hospital for a few days. They will receive pain management and care to prevent complications.
Rehabilitation: Rehabilitation may include physical therapy, occupational therapy, and speech therapy, depending on the patient’s needs. Follow-up appointments are essential to monitor recovery and adjust medications if necessary.

Types of Epilepsy Surgeries

Type of Surgery	Description	Process
Resective Surgery	Removes the part of the brain where seizures originate.	Involves identifying and surgically removing the seizure focus, such as in lobectomy or lesionectomy.
Laser Interstitial Thermal Therapy (LITT)	Uses a laser to destroy seizure-causing brain tissue.	A minimally invasive procedure guided by MRI, where a laser probe is inserted to ablate the targeted area.
Deep Brain Stimulation (DBS)	Implants electrodes to send electrical impulses to the brain.	Electrodes are implanted in specific brain areas and connected to a device that controls the stimulation.
Corpus Callosotomy	Severs the corpus callosum to prevent seizure spread between brain hemispheres.	The corpus callosum is partially or completely cut to limit the spread of seizures.
Hemispherectomy	Removes or disconnects one hemisphere of the brain.	Either the entire hemisphere is removed (anatomical) or disconnected (functional) to control seizures.
Multiple Subpial Transections (MST)	Cuts nerve pathways to prevent seizure spread without removing brain tissue.	Small cuts are made in the brain's outer layer to interrupt seizure pathways while preserving function.
Vagus Nerve Stimulation (VNS)	Uses a device to stimulate the vagus nerve to reduce seizures.	A device is implanted under the skin and connected to the vagus nerve, sending regular electrical pulses.

Epilepsy Treatment

For patients seeking epilepsy, Manipal Hospitals offers comprehensive care, including advanced epilepsy surgery options. Our team of experienced neurosurgeons and neurologists work together to provide personalized treatment plans tailored to each patient’s needs. With state-of-the-art facilities and a commitment to patient-centred care, we strive to achieve the best possible outcomes for epilepsy treatment for our patients.

Latest Advancements

Robotics and AI-Guided Surgical Tools: These technologies enhance the precision and reduce the invasiveness of epilepsy surgeries, allowing for more accurate targeting of seizure foci.
Enhanced Imaging Techniques: Functional MRI and SPECT scans are improving the accuracy of identifying seizure origins, which is crucial for successful surgical outcomes.
Responsive Neurostimulation (RNS): RNS devices detect and respond to seizure activity in real time, helping to prevent seizures before they fully develop.
Stereotactic EEG: This minimally invasive method allows for precise localization of seizure origins in the brain, aiding in more effective surgical planning.

These innovations are making epilepsy surgery safer and more effective, offering new hope for patients who do not respond to traditional treatments. If you have any more questions or need further details, feel free to ask!

Conclusion

Epilepsy surgery is a valuable option for patients who do not respond to medications and continue to experience debilitating seizures. By removing or altering the part of the brain causing seizures, epilepsy surgery can significantly improve the quality of life for many patients. If you or a loved one is struggling with uncontrolled seizures, consult our Neurosurgery specialists at Manipal Hospitals to explore the potential benefits of epilepsy surgery and take the first step towards a seizure-free life.