Epilepsy surgery is a surgical process that helps remove an area of the brain producing seizure and controls seizure activity. This surgery is performed when the seizures occur in a particular area or single location of the brain. Epilepsy surgery is suggested when two anti-epileptic medications have failed to cure the seizures in the brain. This surgery aims to treat brain seizures without affecting the functions of the brain. Before the epileptic surgery, various surgical tests are suggested to check whether the person is eligible for this surgery.
Classification Of Epilepsy Surgery
Epileptic seizures occur due to the abnormal activity of the neurons present in the brain. There are different types of epileptic surgery. The type of surgery depends on the following factors:
Location of the seizure
Types of epileptic surgery;
Resective Surgery - In this type of surgery, a small area of the brain is removed. The surgeon removes the brain tissues of the portion where the seizure occurs. This area is generally a site of malformation, tumour or brain injury. The part of the brain on which the resective surgery is performed is known as the temporal lobes that control emotions, visual memory and language comprehension.
LITT (Laser Interstitial Thermal Therapy) - This type of surgery is less harmful or painful in which a laser is used to point out and remove the brain tissue where the seizure occurred. The laser used by the surgeons is guided by MRI (Magnetic Resonance Imaging).
Deep Brain Stimulation - It is a process in which a device is used that is introduced deep inside the brain. This device sends electrical signals at regular intervals which disturbs the activity of the seizures. The generator which releases these electrical signals is installed in the chest. This whole process is guided by MRI.
Corpus Callosotomy - The part of the brain that connects nerves of the corpus callosum (left and right sides of the brain) is removed in this type of surgery. This surgery is for those children who experience abnormal brain activity that spreads from one side to another side of the brain.
Hemispherectomy - This process is used to remove a hemisphere (one side) of the cerebral cortex (folded grey matter of the brain). The surgery is performed on those children who have seizures that are developed from multiple sites in one side of the brain (hemisphere). This problem in children takes place at the time of birth or early infancy.
Functional Hemispherectomy - It is a procedure to remove the connecting nerves without removing the actual parts of the brain. The surgery is mainly for children.
Eligibility For Epilepsy Surgery
Epilepsy surgery is an option when the medications are not able to control the seizures. The surgery is applicable for those people who have:
uncontrollable seizures or have adverse effects of the anti-seizure drugs.
focal seizures that are generated in localised seizure focus (one area or part of the brain).
seizures that are caused by AVM (arteriovenous malformation), birth defect, scar tissue or brain tumour.
seizures that affect the quality of life.
secondary generalization (seizures spreading to the whole brain).
Surgical Tests For Epilepsy Surgery
A medical team conducts various surgical tests to find whether the person needs epilepsy surgery or not, to determine the seizure affected area of the brain and to understand the functions of the brain.
These tests are described below:
Tests for finding the surgical area
EEG (Baseline electroencephalogram) - Through this test, affected areas of the brain are determined. In this test, the electrical activity of the brain is measured by placing electrodes on the scalp.
Video EEG - This test is conducted when the patient is admitted to the hospital. The video EEG helps to monitor and record the seizures. The EEG changes are evaluated with the body movements to find the area of the brain where the seizures are developing.
MRI (Magnetic resonance imaging) - In this test, radio waves and magnetic fields are used to get detailed images of the tumours, damaged cells and other factors that can cause seizures.
Tests for finding the nature of the abnormal activity and localizing the source of seizure
Invasive EEG Monitoring - If a normal EEG doesn’t provide correct results then, the surgeons go for an invasive EEG monitoring test. In this test, doctors place strips or grids of the electrodes on the brain surface or are inserted deep inside the brain.
Video EEG using invasive electrodes - The surgically placed electrodes are also required for the process of video EEG. The EEG and video data are recorded after the surgery. But the patient is not given any medications during a medical stay.
PET (Positron emission tomography) - It is an imaging device that is used to measure the functions of the brain. The images can be analyzed alone or can be combined with the data of the MRI to find the source of errors.
SPECT (Single-photon emission computerized tomography) - This test is used to measure the flow of blood during a seizure. It is seen that the flow of blood is higher in the part of the brain where the seizure occurs.
Tests for understanding the functions of the brain
Functional MRI - This test helps the surgeons to identify the regions of the brain that control a particular function.
Wada Test - In this test, a mediation is injected to temporarily put one side of the brain to sleep. After this, a test is conducted for memory and language function. The test is useful in determining the side of the brain which is dominant for language usage.
Brain Mapping - In this surgical test, the electrodes are surgically placed on the brain surface. The patient is asked to perform certain tasks that match with the data of the electrical activity of the brain.
Neuropsychological Tests - These additional tests are recommended to determine memory function and non-verbal and verbal learning skills. Also, the affected areas of the brain are identified through these tests.
Complications In Epilepsy Surgery
Each surgery has some risks. The risks in epilepsy surgery depend on the type of surgery and surgical site. Following are some complications in this surgery:
Reactions to anaesthesia
Language and memory problems
Mood swings or depression
Procedure Of Epilepsy Surgery
Oxygen levels, heart rate and blood pressure of the patient are monitored throughout the surgery. An EEG monitor is used to record the brain waves during the operation to localize the seizure affected part of the brain.
The patient is given anaesthesia so he may remain unconscious during the operation. In some cases, the patient is awakening so that surgeons determine the part of the brain which controls movement and language. In these cases, patients are given some medicines to bear the pain.
Depending upon the type of surgery, the surgeons make a small window or hole in the skull. After the completion of the surgery, the bone window is replaced and the remaining skull is sealed for healing.
After the surgery
When the surgery gets completed, the patient is shifted to ICU (intensive care unit) where he is examined by the doctors. The hospital stay for epilepsy surgery is about 3 to 4 days.
When the patient is awakened, his head will be painful and swollen. They are given narcotics as painkillers. The ice bag is also helpful in reducing the pain. Most of the swelling and pain resolves within a few weeks.
The patients are advised to take complete bed rest for some weeks after the surgery and gradually increase their daily physical activities.
Outcomes Of Epilepsy Surgery
The result of epilepsy surgery depends on the type of surgery. The most expected and common outcome is successful surgery (seizure control) with anti-epileptic drugs.
If the patient does not have a seizure for at least one year then, the doctor considers discontinuing the medications. If they feel seizure after taking off the medications then, their seizure control is resumed through anti-seizure drugs.
How can CARE Hospitals help?
At CARE Hospitals, we provide comprehensive care and personalized treatment for epilepsy. Our experienced multidisciplinary team provides proper assistance during the patient's recovery period. Our advanced minimally invasive procedures can help people improve their quality of life.
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