When surgery is considered
Despite trying a number of medications some people still continue to have seizures. There are other treatment options available to help manage epilepsy and seizures.
One of these options is surgery.
Some people, predominantly those with focal epilepsy, may benefit from surgery. Sometimes epilepsy is caused by a small (focal) area of abnormal brain tissue. The abnormal tissue may be a result of some form of head injury, brain infection, or abnormal development – which can become the focus of seizures.
The goal of epilepsy surgery is to stop or considerably reduce seizures without causing any neurological deficits or problems. Surgery is not usually performed unless it is likely the person will gain significant benefits.
The most common type of epilepsy surgery aims to remove the epilepsy ‘focus’ – that is, where the seizures start in the brain. Sometimes this focus is obvious and can be seen on scans, and sometimes it is not any may only be detected after a period of monitoring.
Surgery may be considered when:
- Seizures are not responding to medication
- There is a focal onset of the seizures
- Seizures are of a particularly dangerous or debilitating type (such as ‘drop attacks’ or status epilepticus)
- Seizures occur many times a day, making normal life impossible
- The cause of the seizures requires surgery, such as a brain tumour
Epilepsy surgical programs are based in epilepsy centres at major public hospitals. The work-up to surgery involves a number of tests and monitoring and recording of seizures.
There is a chance that at the end of the work-up, tests may show that surgery is not possible without risk.
What happens?
A large range of tests are done to pinpoint what part of the brain the seizures are originating from. These will be explained to you before they are done. This is an important time to ask questions.
The tests often include:
- Videotelemetric EEG (VEEG)
- MRI scan
- SPECT scans
- PET scan
- Neuropsychological evaluation
- Psychiatry visit
- A routine visit from a psychiatrist is common. The surgical program is not easy and is a stressful time. The psychiatrist will assess how you are coping, how you may cope with surgery and help you to move towards a positive outcome.
Once the entire work-up has been finished, test results are put together and compared. A team decision is made as to whether successful surgery is possible. Depending on this outcome, there may be a few further tests to follow.
Making the decision to have surgery can be very stressful. Before surgery, it is essential to discuss all your worries or concerns with your neurologist and epilepsy nurse.
If your seizures are not well controlled with medication, speak with your doctor about surgery as an option for you.
If you would like to know more about surgery for epilepsy, speak to your doctor or ask to be referred to an epilepsy centre for a review.
For more information about surgery:
Factsheet – Surgery for Epilepsy
Listen to Neurosurgeon Erica Jacobson answering questions about surgery for epilepsy.
