Medication controls seizures or epilepsy in most of the people, surgery is recommended to those few, where at least two anti-seizure or anti-epileptic medications prove to be ineffective. Surgery works best in those people where epilepsy originates from the same area of the brain. A surgery can control seizure and improve the quality of life.
The main goal of performing surgery is to remove the area that causes seizures, disrupt the pathway that the seizure takes through the brain, and the implantation of a device to treat epilepsy.
Who is Recommended Surgery for Epilepsy?
Surgery for epilepsy is recommended to those,
- Patient in whom the seizures focus (exact area of origination of seizure) is identified.
- Removal of the area does not disrupt the important functions such as language, sensation, and movement.
- A person is suffering from disabling seizures.
- The side effects of the medication given to control epilepsy are affecting the quality of life.
- The doctor has tried at least two anti-epileptic medications, which prove to be ineffective in controlling seizures.
- If a patient is suffering from serious medical illnesses such as cancer or heart disease, they aren’t recommended for this procedure.
Surgical Options for Epilepsy
Surgery can reduce seizures and sometimes even eliminate them in most of the people. The various options are detailed below.
The cerebrum or the largest part of the brain is divided into, the frontal lobe, the occipital lobe, the parietal lobe, and the temporal lobe. The surgeon recognizes the seizure focus and removes the brain tissue in that area. The surgeon might also remove the brain lobe or a portion of the brain lobe if required.
Lesionectomy involves removal of any kind of lesion in the brain such as a tumor or a malformed blood vessel responsible for causing a seizure. The occurrence of seizure stops once these lesions are removed.
The two halves of the brain are connected by a band known as the corpus callosum. Corpus callosotomy (cutting off the corpus callosum) is done to prevent the spread of seizure from one part of the brain to other. It is also known as the split brain surgery.
This surgery is done mostly in those people suffering from severe and intense seizures which can lead to serious injury.
Functional hemispherectomy involves disconnecting the entire hemisphere from the rest of the brain. Unlike hemispherectomy where the half of the brain is removed, in functional hemispherectomy, the hemisphere stays in place. This surgery is mostly performed in children younger than 13 years, where the hemisphere is not performing that way it should.
Multiple Subpial Transaction (MST)
Multiple subpial transaction is a rare procedure, performed in those people who have seizure originating from those areas of the brain that cannot be removed. Series of cuts are made in the brain tissue, which interrupts the flow of seizure impulses. This procedure does not interrupt the brain activity and helps leave the abilities intact.
Vagus Nerve Stimulation
Vagus nerve controls the activity between the brain and the major internal organs. Vagus nerve stimulation involves implanting a device beneath the skin which sends impulses to the vagus nerve. The procedure helps in lowering the seizure activity.
Responsive Neurostimulation Device
In responsive neurostimulation device, electrodes are put on either side of the brain. These electrodes are connected to a device which is placed in the skull just below the scalp. This device detects any abnormal activity in the brain and sends an electric current, which can stop the process which leads to seizure.
Risks Associated With Surgery for Epilepsy
The risks depend on the type of surgery performed for epilepsy. The common risk include:
- Allergic reaction to the anesthesia
The surgery specific risks are,
- Loss of Memory: Surgery of temporal lobe might affect the memory of the person and also the language ability. The person may find difficulty in remembering, understanding, and speaking.
- Problems in Vision: Surgery of the temporal and occipital lobe may lead to double vision or other vision problems.
- Changes in Behavior: Surgery of the frontal lobe may affect the behavior such as attention, concentration, and motivation.
- Reduced Visual Field: Patient experience reduced visual field after epilepsy surgery.
Most of the time, after the surgery, a patient feels completely free from epilepsy or seizures. If the seizures are still present the doctors might prescribe an anti-seizure drug, which he would reduce or stop if the seizures are under control.
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- What Causes Epilepsy or an Epileptic Seizure & Can Epilepsy Go Away On Its Own?
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