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Epilepsy Surgery

Epilepsy Surgery
As each person’s experience with epilepsy is unique, treatments that work for one individual may not work for others. For some people, seizures cannot be controlled by medications. In this case, surgery may be an option. To be considered a candidate for surgery, a patient must have tried at least three different anti-epileptic medications and had unsuccessful results.

Before surgery, extensive testing may be done in order to both maximize seizure control post-procedure and to minimize any disruption of brain functioning. These tests may include an evaluation of the patient’s current status (assessments might be done by doctors, psychiatrists, nurses or social workers), confirmation of the location of seizure activity and assessing other areas of the brain in order to anticipate any problems the patient may experience. This can be done through EEG (Electroencephalography) monitoring, MRI (Magnetic Resonance Imaging) and the Wada (Intracarotid Sodium Amobarbital test) as well as brain mapping at the time of surgery.

A temporal lobectomy is both the most common and the most successful type of epilepsy surgery. This procedure involves the extraction of a portion of the temporal lobe. Post-surgery, on average 60-70% of patients find that seizures that previously occured caused atypical behavior or impaired consciousness have been eliminated, although some patients may continue to experience auras. 20-25% of patients may still experience tonic-clonic or complex partial seizures, but their frequency can be reduced by over 85%. The percentage of patients who see no worthwhile improvement after surgery is approximately 10-15%. Most doctors will recommend patients continue taking their prescribed anti-epileptic medication for a period of time after the surgery; however the dose may be reduced. As well, medication may be eventually stopped in 25% of patients who are seizure free.

The second most common type of epilepsy surgery is the frontal lobectomy. It involves the removal of a section of the frontal lobe. It is not as successful as the temporal lobectomy; however, consciousness impairing and atypical behavior causing seizures are eliminated in 20-25% of patients. Complex partial or tonic-clonic seizures may still be experienced by 20-40% of people; however their numbers can be reduced by up to 90%. In total, at least 70% of patients experience significant improvement after completing this procedure. Most will have to continue taking medication, but their doctors may choose to reduce the dosage.

Other procedures include parietal and occipital lobectomies, where a portion of either of these lobes located at the back of the brain, is removed. In a hemispherectomy the surgeon disconnects a part of the brain from the rest. In this way, seizures are isolated and prevented. This procedure is used only in people with extreme epilepsy originating from one hemisphere of the brain.

Deciding to undergo epilepsy surgery is a big decision. Surgery might be able to help where medication has failed; however, it comes with its own risks. Like all medical decisions, it is important to consider both the risks and the benefits. Surgery can be a scary, but beneficial treatment option for people living with epilepsy. This subject can always be discussed with your neurolgoist any time you have questions or are wondering about your own suitability for surgery. Choosing to undergo brain surgery is not a decision to be taken lightly, and there is a great deal of consultation, testing and evaluation done prior to a surgery ever being scheduled. If you and your neurologist are considering surgery as a next step, please know that if you were not a suitable candidate, the option would not be on the table for you and if your neurologist and surgeon were not confident in a positive outcome post-surgery, they would not be considering it as well.

If you have any questions about epilepsy surgery, please give us a call at (403) 230-2764 or send our Support Coordinator an email at michelle@epilepsycalgary.com


References:
Epilepsy surgery. (2012, October 19). Retrieved January 23, 2015, from www.mayoclinic.org/tests-procedures/epilepsy-surgery/basics/definition/PRC-20014204
Surgery. (2013, August ). Retrieved January 23, 2015, from www.epilepsy.com/learn/treating-seizures-and-epilepsy/surgery



Shania Kelly
MRU Social Work Practicum Student
January 2015