Epilepsy surgery is a procedure that either removes or isolates the area of your brain where your seizures originate. If the section of your brain where your seizures begin is too vital to remove, your surgeon will make a series of incisions that prevent your seizures from spreading to the rest of your brain.
Epilepsy surgery works best for people who have seizures that always originate in the same place in their brains. To be considered for epilepsy surgery, you must have tried at least two anti-seizure drugs without success. If two appropriate drugs have failed, it is highly unlikely that any other anti-epileptic drug will help you.
Why it's done
In most cases, epilepsy surgery can reduce — and sometimes even eliminate — your seizure activity. Repeated epileptic seizures can cause:
The type of epilepsy surgery you may have depends on the types of seizures you experience and where they begin in your brain. They include:
Location of temporal lobe
The temporal lobe is located along the sides of your brain. ...
Your brain is divided into two halves, called hemispheres. ...
Your risks may vary, depending on which variety of epilepsy surgery is used and the portion of your brain involved:
How you prepare
If you're a candidate for epilepsy surgery, your pre-surgical evaluation may include:
Pinpointing seizure location
This example shows SPECT scans taken during and between seizures. The differences represent areas where blood flow increased during the seizure. Once identified, that location is fitted onto an MRI ...
What you can expect
During the procedure
You will have an intravenous access in place, and your heart rate, blood pressure and oxygen levels will be monitored throughout the surgery. An EEG monitor also may be recording your brain waves during the operation to better localize the part of your brain where your seizures start.
Epilepsy surgery is usually performed during general anesthesia. That means you'll be unconscious during the procedure, which involves making a small opening in your skull to access the brain. In rare circumstances, your surgeon may wake you up during part of the operation to help the team determine which parts of your brain control language and movement. After surgery the window of bone is replaced and fastened to the remaining skull for healing. Most epilepsy surgeries take at least four hours.
After the procedure
When you awaken, your head will be swollen and painful. Most people need narcotics for the pain for at least the first few days. An ice pack on your head also may help. Most postoperative swelling and pain resolve within several weeks.
You'll probably not be able to return to work or school for approximately three months. You should rest and relax the first few weeks after epilepsy surgery and then gradually escalate your activity.
It's unlikely that you would need any rehabilitation as long as the surgery was completed without complications. Complications — such as stroke, paralysis or loss of speech — occur in about 1 percent of temporal lobe resections — the most common variety of epilepsy surgery.
Seizures that begin in the temporal lobe are the most likely to be resistant to medication, but they are also the most likely to be helped by epilepsy surgery. Nearly 90 percent of people who experience temporal lobe seizures see a significant reduction or even a cessation of seizures after epilepsy surgery.
You must continue to take anti-seizure medications after epilepsy surgery, to help improve your chances of remaining seizure-free. Your doctor may be able to wean you off anti-seizure drugs after a year or two.
Last Updated: 2010-05-08
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