Epilepsy surgery involves a neurosurgical procedure where an area of the brain involved in seizures is either resected, disconnected or stimulated.[1] The goal is to eliminate seizures or significantly reduce seizure burden. Approximately 60% of all people with epilepsy (0.4% of the population of industrialized countries) have focal epilepsy syndromes. In 15 to 20% of these patients, the condition is not adequately controlled with anticonvulsive drugs. Such patients are potential candidates for surgical epilepsy treatment.
Frequently asked questions about Epilepsy
Q.What is epilepsy surgery?
Epilepsy surgery is a special kind of brain surgery wherein the small part of brain which is responsible for uncontrolled epilepsy can be safely removed without causing any harm.
Q.What can be done for medically refractory epilepsy?
These patients definitely require pre-surgical evaluation for the possibility of surgery to control their seizures.
- To establish the diagnosis of epileptic seizure
- Define the kind of epilepsy
- Define the area of brain responsible for the seizures
- Evaluate for any abnormal area on special MRI
- Select ideal surgical candidates with very good correlation
- Ensure that the surgery will not result in disabling neuro-psychological deficits, by carrying this out at a dedicated Epilepsy Centre.
Q.What is presurgical evaluation?
Pre-surgical evaluation includes Video-EEG monitoring, MRI Brain (epilepsy protocol), PET/SPECT -in selected cases, neuropsychological evaluation and psychiatric evaluation in selected cases. Once the work-up is over, this data is discussed in multidisciplinary patient management conference which includes epileptologist, neurosurgeon, neuro-radiologist , neuro-psychiatrist etc.
Advanced Surgical Procedures for Management of Epilepsy
Depending on the particular clinical situation, one of the following surgical procedures is chosen by the Medical team at our affiliate hospital. These operations either aim to resect the disease area of the brain, to disconnect it from other areas so as to relieve the seizures, or to lessen their impact.
- Anteromedial Temporal Lobectomy
- Selective Amygdalohippocampectomy
- Electrocorticography guided Resections
- Multiple Subpial transections
- Multiple Subpial transections
Quadrantic Resections
- Functional Hemispherotomy
- Vagal Nerve stimulation
- Radiosurgery (selected cases)
Selection of Cases
Carefully selected patients with intractable epilepsy can have a gratifying outcome in majority of cases. The 2 key points that enable proper selection of cases are:
- Concordant demonstration of Epileptogenic zone on all the specialized investigations: 3T MRI, PET/SPECT scan, videoEEG, Neuropsychological assessment and clinical evaluation. This means all the tests should point to fits coming from same area of the brain.
- Can the area of origin of fits be operated safely without producing deficit. This has to be judged by a surgeon experienced with such procedures.
Once the above two conditions are met, the patient can be further counselled and likely outcome explained keeping in mind the specific situation. For example, surgery for seizure focus in temporal lobe of the brain has a better outcome than other areas. Similarly, cases wherein MRI shows abnormal area have greater chances of success than those in which MRI is completely normal.
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