When surgery is considered
Despite trying a number of medications some people still don’t get good seizure control. There are now other treatment options available to help manage epilepsy and seizures.
One of these options is surgery.
Sometimes epilepsy is caused by a small 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 later turn into scar tissue and become the focus of seizures.
Some people, predominantly with focal seizures, can benefit from surgery. The goal being to stop or significantly 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 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 is 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 programs for surgery are based in major public hospitals. The build up to surgery involves a number of tests and prolonged 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.
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:
- Videotelemetry EEG
- 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 stressful. The psychiatrist will assess how each person is coping, how they may cope with surgery and help them move towards a positive outcome.
Once the entire work-up has been finished, a team conference is called including the person with epilepsy, and a 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.
For more information about surgery:
EAA Seizure Smart – Surgery for Epilepsy factsheet.
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