Diagnosis of Epilepsy, Epilepsy Treatment, Epilepsy Management, Seizure, Epileptic Seizure

DIAGNOSIS & TREATMENT

Surgery

In recent years surgery has become a well-recognised treatment for some types of epilepsy, however, for most people with epilepsy brain surgery or other surgery is not an option.

In some cases, epilepsy can originate from an area of abnormal brain tissue. The size and position of this abnormal tissue, referred to as the epilepsy focus, varies between individuals. Until recently, scanning techniques were not precise enough to accurately pinpoint the epilepsy focus when it occurred deep within the brain. This made it extremely difficult to surgically remove the epilepsy focus and leave the surrounding areas and their functions unaffected.

Today's improved and creative scanning techniques now allow otherwise hidden areas of abnormal brain tissue to be precisely identified and improved surgical techniques provide the possibility for their safe, surgical removal.

Current surgical procedures include different types of lobectomy (temporal, frontal), topectomy (excising a small area relating to the seizure focus itself), or hemispherectomy (removal of one-half of the brain).

Procedures that can improve quality of life are the corpus callosotomy (disconnecting the two sides of the brain) and multiple pial transections (where shallow cuts into the brain’s cerebral cortex interrupt connecting fibres, thereby reducing or eliminating seizures).

If surgery is an option for you it doesn’t happen straight away. Several months of extensive testing and counselling are undertaken before surgery is performed. Specialised literature on epilepsy surgery is available from the Epilepsy Foundation Library.

• Temporal lobectomy
• Frontal lobectomy
• Corpus callosotomy
• Hemispherectomy
• Vagus Nerve Stimulation Therapy

Temporal lobectomy

This is the most common type of epilepsy surgery and is also the most successful in selected children and adults with uncontrolled complex partial seizures. The temporal lobes are common sites of simple and complex partial seizures, some of which may secondarily generalise. All or part of a left or right lobe may be removed surgically if the seizure-producing area can be safely removed without damaging vital functions.

Frontal lobectomy

This is the second most common type of epilepsy surgery. Partial seizures often arise in the frontal lobes and surgery can result in great improvement in seizure control in at least 70 percent of patients.

Corpus callosotomy

The corpus callosum is a nerve bridge that connects the hemispheres of the brain and integrates brain function. By surgically separating the two halves of the brain the spread of an epileptic discharge can be confined to one cortex resulting in partial seizures rather than severe generalised seizures.

Hemispherectomy

This is the removal of all or most of one hemisphere and is performed in the most exceptional cases, mainly infants and very young children with totally uncontrolled seizures.

Vagus Nerve Stimulation Therapy (VNS)

Another procedure that offers improved seizure control for some people is the vagus nerve stimulator.

This device is implanted just beneath the pectoral or chest muscle. Much like a pacemaker to look at, it has a lead that attaches to the vagus nerve in the neck and emits a regular electrical impulse. By stimulating the vagus nerve, it is thought that the brain’s potential to generate or spread abnormal seizure activity can be reduced.

The vagus nerve serves as one of many highways of information carrying messages to and from the brain. Nerve fibres in the vagus nerve relay information from the body’s organs, such as the stomach and heart, to the brain. The vagus nerve has many connections to areas in the brain instrumental in producing seizures.

Implanting a vagus nerve stimulator is generally only considered if Antiepileptic Drugs are not controlling the seizures satisfactorily and other surgical options have been ruled out.

The operation to implant a vagus nerve stimulator takes approximately two hours. Over the following two days, the device is programmed to automatically deliver stimulation on a regular, frequent basis, usually every 300 seconds, around the clock.

Not all types of epilepsy will respond to this treatment. Your neurologist can determine if this treatment is an option for you.

In relation to any surgery, while the best possible outcome is anticipated for each patient, no surgical procedure is risk-free. Successful surgery, however, can prevent seizures from occurring, or dramatically reduce seizure frequency and thereby change a person’s life forever.

 

Related Articles