If you have epilepsy and medication isn’t controlling your seizures to the extent you would like, it might be time to consider epilepsy surgery. Adults with epilepsy are not required to wait years for surgery. In fact, studies show that earlier surgery is better to prevent a decline in thinking and functioning caused by uncontrolled seizures.
Newer, minimally invasive surgical options offer many patients a better overall experience with fewer side effects. Surgical options also now exist for poorly localized seizures, offering nearly every adult with epilepsy a surgical option.
But because epilepsy surgery has not been commonly available, many physicians who provide routine care for patients with epilepsy often do not often recommend surgery. That is changing for the better as community-based surgery becomes more common. At Neurosurgery One, we perform epilepsy surgery at Littleton Adventist Hospital, which houses one of the region’s leading Epilepsy Monitoring Units and has a clinical team specially trained in the treatment of epilepsy.
The most important thing that patients with epilepsy and their physicians should be aware of is that almost every adult epilepsy patient uncontrolled by medication will likely benefit from a surgical option. The surgery may not completely cure the problem, but there will be benefit.
The CDC estimates there are nearly 60,000 people living in Colorado who have epilepsy. Of adults, more than half who take medication still have seizures and one-third are unable to work. Research shows that the longer seizures are uncontrolled, the greater the decline in cognitive function and socio-economic status. I encourage patients and their doctors to consider surgery earlier rather than later.
Choosing the Best Surgery for Each Patient
To plan for surgery, we work with epileptologists at Littleton Hospital’s Epilepsy Monitoring Unit to conduct non-invasive testing to locate the cause of the seizures. These tests can include EEG, MRI, PET, or SPECT. If these test results are inconclusive or conflicting, we can perform intracranial EEG monitoring to get a more detailed look at the brain activity.
Once the cause and location of the seizures is determined, we will work with the epilepsy team and the patient to determine the most appropriate surgery. Surgical options include:
- Ablation: Laser Interstitial Thermal Therapy (LITT) uses laser heat to destroy the small area of the brain causing the seizures. This procedure is highly effective, with 60% cure rates.
- Responsive Neurostimulation (RNS)/NeuroPace: Like a pacemaker, this implanted device monitors brain waves and automatically sends electrical pulses when unusual patterns are recognized.
- Vagus Nerve Stimulation: A pacemaker-like device is implanted in the chest, and a wire is wrapped around the vagus nerve in the neck. The device sends regular, mild electrical pulses to the brain, preventing seizures.
- Deep Brain Stimulation: Approved by the FDA in late 2018 for use with patients with epilepsy, this system works like the NeuroPace system. At Neurosurgery One, DBS is performed using robotic guidance while patients are asleep. Pulse generator placement is conducted in an out-patient surgery center rather than requiring a subsequent hospital admission.
- Resection: This is the most common epilepsy surgery due to how long it has been available. Resection is brain surgery that involves removing the small portion of the brain responsible for creating the seizures, an area referred to as the seizure focus
Andrew Romeo, MD, is a neurosurgeon who sees patients in the Neurosurgery One Littleton and Lone Tree medical offices. Dr. Romeo has specialized fellowship training in functional neurosurgery, which is the treatment of movement disorders including epilepsy. To see the medical research mentioned in this article, please go to the Epilepsy Research page.