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Surgical Procedures for Epilepsy
Surgery to treat epilepsy is most likely to be successful when:
- Seizures occur in just one part of the brain—partial or focal seizures
- Seizures begin as partial seizures before spreading to the rest of the brain
- Medications do not control the seizures or they cause severe negative side effects
- It is used to remove the underlying cause of the seizures, such as a brain tumor or excess fluid on the brain
- There is unilateral multifocal epilepsy with infantile hemiplegia, such as Rasmussens encephalitis
Before the decision to have surgery is made, you and your doctor must consider the following factors:
- Frequency and severity of your symptoms
- The area of the brain involved, and the importance of that area to everyday life
The main types of surgery used to treat epilepsy are:
Lobectomy or Lesionectomy
This procedure involves removal of the area of the brain that is producing the seizures, called the seizure focus. This procedure is only appropriate in patients who have partial seizures that occur in just one part of the brain. The surgery is often successful in reducing seizure frequency. It is especially useful in patients with certain kinds of temporal lobe epilepsy.
Multiple Subpial Transection
This involves a series of cuts along the nerve path by which seizure impulses spread. The surgery is designed to prevent seizures from spreading into other parts of the brain, while leaving the patient’s normal abilities in place. This is sometimes done alone and sometimes done in addition to a lobectomy. Alone, it is done in patients whose epileptic seizures occur in a part of the brain that cannot be removed. This surgery improves seizure control about 70% of the time. Multiple subpial transection is done less often than a lobectomy.
This surgery involves cutting the nerve connections between the right and left hemispheres of the brain to prevent seizures from spreading from one side to the other. It is often done in two steps. The first operation partially separates the two halves of the brain, but it leaves some connections in place. If the generalized seizures stop, no additional surgery is done. If seizures continue, a second operation that completes the separation may be done.
Corpus callosotomy is done primarily in children with severe seizures that start in one hemisphere of the brain and spread to the other. The surgery can help prevent generalized seizures. However, the surgery does not prevent seizures in the side of the brain where the seizure originates.
This surgery involves the removal of half of the brain's outer layer, called the cortex. It is usually done only in children whose epilepsy is not responding well to medication and who have one of these conditions:
- Rasmussens encephalitis
- Other severe damage to one brain hemisphere
Recovery requires intense rehabilitation in order to regain normal functions. However, after this surgery, children usually:
- Have seizures greatly reduced or even eliminated
- Recover well from the surgery
Often recover nearly normal activities—however, there will be:
- Weakness and loss of some movement on one side of the body
- Loss of side vision
About half of patients need to remain on their medications after this surgery. And, about half can slowly be tapered off medications if they are seizure-free for 12 months.
The chance of recovery from this surgery is best in young children. Therefore, a hemispherectomy is done as early as possible in a child’s life and almost never done in children over age 13.
There are two U.S. Food and Drug Administration (FDA)-approved devices that are surgically implanted under the skin. The devices help manage seizures in people whose symptoms are not well-controlled with medication.
- Vagus nerve stimulator—delivers short bursts of electricity to the brain via the vagus nerve in the neck
- Responsive neurostimulator—detects electrical activity in the brain and delivers electrical stimulation before seizure symptoms occur
Epilepsy in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 11, 2014. Accessed February 17, 2014.
Epilepsy in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 11, 2014. Accessed February 17, 2014.
FDA approves medical device to treat epilepsy. US Food and Drug Administration website. Available at: http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm375041.htm. Accessed February 17, 2014.
NINDS Epilepsy information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm. Updated February 14, 2014. Accessed February 17, 2014.
US approves antiepileptic brain implant. Epilepsy Research UK website. Available at: http://www.epilepsyresearch.org.uk/us-approves-antiepileptic-brain-implant/. Published November 15, 2013. Accessed February 17, 2014.
What is epilepsy? Epilepsy Foundation website. Available at: http://www.epilepsyfoundation.org/aboutepilepsy/whatisepilepsy/index.cfm. Accessed February 17, 2014.
Wiebe S, Blume WT, et al. Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001 Aug 2;345(5):311-318.
- Reviewer: Rimas Lukas, MD
- Review Date: 03/2015
- Update Date: 03/15/2015