Epilepsy Surgery Helps Control Seizures

If you are one of the four in 10 adults with epilepsy whose medication doesn’t adequately control your seizures, epilepsy surgery can help. Epilepsy surgery eliminates disabling seizures in 60 percent of patients who do not respond to anti-epileptic drugs (AEDs), according to research studies.

Today thanks to advancements in technology and epilepsy research, nearly every adult with uncontrolled seizures is now a candidate for epilepsy surgery. The Denver neurosurgeons at NeurosurgeryOne are specially trained in epilepsy surgery. We partner with you to determine your goals for epilepsy surgery, review your seizure history, conduct testing, and create a plan.

 

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What is epilepsy?

Epilepsy is a neurological disorder characterized by seizures. Seizures happen when regular brain function is disturbed by excited electrical signals. There are many different types of seizures that start in different areas of the brain and affect different parts of the body. Epilepsy is most common in young children and older adults, but the condition can affect people at any age.

Some types of epilepsy are inherited, others are caused by brain injuries, and still more have an unknown cause. A first seizure that cannot be explained by a medical problem has about a 25% chance of returning. A second seizure occurrence means about a 70% chance of future seizures, and a diagnosis of epilepsy.

Doctors have identified two main types of seizures:

  • Partial seizures are more common than generalized seizures and occur in one or more areas of the brain. Partial seizures are likely to develop from a specific cause or injury but can develop for no known reason. Partial seizures are organized into two categories – simple and complex. Someone having a simple partial seizure does not lose consciousness, and the episode typically lasts about 90 seconds. Someone having a complex partial seizure may lose consciousness briefly, and the episode typically lasts no more than two minutes. A little more than half of adult seizures are complex partial.
  • Generalized seizures take place over a larger area of the brain, which leads to more serious effects for the person having a seizure. Generalized seizures are organized into two main categories – grand mal and petit mal. Someone having a grand mal seizure will most likely lose consciousness without warning, with the entire episode lasting     2-3 minutes. Someone having a petit mal seizure will lose consciousness for 3-30 seconds, and others may not even realize what is happening. A person may experience as many as 50-100 petit mal seizures per day.

 

How is epilepsy diagnosed and treated?

Epilepsy is often diagnosed after a visit to the emergency room for a seizure. The most important tool for diagnosing epilepsy is an electroencephalogram (EEG), ideally performed within 24 hours of a suspected seizure. EEG is a noninvasive test that evaluates the electrical activity in the brain. EEG tests can last from under an hour to an entire day, or even longer for patients who do not respond to medications. Multiple tests may be needed, particularly for some types of partial seizures, which can show up as normal on an EEG.

First-time seizures are frequently tested with computerized tomography (CT). Your doctor may decide to do a CT in addition to another test, which could include magnetic resonance imaging (MRI) or positron emission tomography (PET). Often these extra tests are done when other tests do not produce quality results. The course of treatment will vary depending on the type of seizure and how often they occur.

Anti-epileptic drugs (AEDs) are used for patients who have had two or three seizures, or after a single seizure if tests show that the person is at risk for another. Treatment for epilepsy is often limited to a single medication, but doctors will add medicines if the condition does not improve. In about 40% of patients, drugs will not control epilepsy symptoms. In people whose epilepsy is not helped with medications, surgery may be a better alternative.

 

Am I a candidate for epilepsy surgery?

The goal of epilepsy surgery is to reduce or eliminate seizure activity while avoiding damage to other areas of the brain. At NeurosurgeryOne, our Denver neurosurgeons offer five different types of epilepsy surgery and will discuss the various surgical options with you.

If you are experiencing uncontrolled seizures more frequently than you would like, you may be a candidate for epilepsy surgery. You do not have to wait a certain amount of time before considering epilepsy surgery, and research shows that earlier surgery may be better.

Candidates for epilepsy surgery typically must meet only these criteria:

  • Seizures failed to be controlled with at least two different types of anti-epileptic drugs (AEDs)
  • General good health

If you have been diagnosed with a mental illness, such as anxiety or depression, you may have been told you do not qualify for epilepsy surgery. However, often mental illness is a direct result of seizures and does not automatically eliminate you from qualification. At NeurosurgeryOne, we can help determine if you are a candidate for epilepsy surgery and help you navigate the process.

 

When should I consider epilepsy surgery?

Studies show that earlier surgery is better to prevent a decline in thinking and functioning caused by uncontrolled seizures. Historically, there has been more than a 20-year delay in referring epilepsy patients for surgery. However, one study found that newly-diagnosed temporal lobe epilepsy patients who underwent surgery combined with medications were much more likely to be seizure free than patients who only took medication. Another study found that for frontal lobe epilepsy, younger age and shorter epilepsy duration at time of surgery resulted in better seizure outcomes.

 

What types of surgery are used to treat epilepsy?

NeurosurgeryOne’s fellowship-trained neurosurgeons located in the Denver area specialize in treating patients with epilepsy who could benefit from the following types of epilepsy surgery:

  • Resections: The most common type of epilepsy surgery, this procedure removes the small part of the brain causing seizures.
  • Thermal/Laser Ablation: Also known as Laser Interstitial Thermal Therapy (LITT), ablation uses laser heat to destroy the small area of the brain causing the seizures.
  • Responsive Neurostimulation (RNS)/NeuroPace: Similar to a heart pacemaker, this implanted device monitors brain waves for unusual patterns indicating a seizure and automatically sends electrical pulses to interrupt seizure activity.
  • Vagus Nerve Stimulation (VNS): 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 (DBS): Approved by the FDA in late 2018 for use with patients with epilepsy, this system works similar to the NeuroPace system. NeurosurgeryOne is a world leader in performing DBS epilepsy surgery using robotic guidance while patients are asleep. Also, the pulse generator placement is conducted in our outpatient surgery center rather than requiring a subsequent hospital admission.

 

Read more about epilepsy surgery.

 

What should I ask a neurosurgeon about epilepsy surgery?

Choosing a neurosurgeon for your epilepsy surgery should be an important part of your process. To help you find a neurosurgeon you trust and who can help you accomplish your goals, consider asking the following questions:

  • Do you have extensive training or are you fellowship-trained in neurosurgery?
  • Do you specialize in the treatment of epilepsy?
  • Have you completed this procedure before? If so, how many times?
  • What are the most common complications of this procedure?
  • What is your infection rate?
  • What is your patients’ success rate with seizure freedom with this type of surgery?
  • What does recovery from this procedure entail?
  • Where do you perform surgery?
  • What types of epilepsy surgery do you offer?

It’s also important to assess your comfort level with a neurosurgeon and his/her staff before you move forward with epilepsy surgery. Consider reviewing the following:

  • How do you feel when you walk into the office?
  • Do you feel comfortable with the neurosurgeon?
  • Are the neurosurgeon and his or her team friendly and competent in addressing your concerns and understanding your goals?
  • Do you feel like you have the neurosurgeon’s full attention?
  • How do you feel about the access you have to the neurosurgeon and/or staff? Can you call, text, email directly or do you need to work through an assistant or nurse?
  • Are the staff helpful with paperwork, travel plans, scheduling, etc.?

 

How do I prepare for epilepsy surgery?

Once you have made the decision to move forward with seizure surgery, you will want to do the following to ensure the best recovery from epilepsy surgery:

  • Continue your medications as instructed by your epilepsy team
  • Maintain a healthy diet and keep well hydrated
  • Get adequate sleep
  • Stay active
  • Foster your support system
  • Discuss your surgery with your primary care physician
  • Complete pre-surgery tests and lab work
  • Follow any pre-surgery instructions recommended by your epilepsy team. You may need to discontinue certain medications that could impact surgery.

With our expert epilepsy team at NeurosurgeryOne in Denver, we will work closely with you every step of the way.

 

What can I expect before, during and after epilepsy surgery?

Before epilepsy surgery

To determine which type of seizure surgery may be right for you, NeurosurgeryOne partners with you through the following steps:

  1. Our neurosurgeon who is specially trained in treating epilepsy will meet with you to determine your goals, review your seizure history to date, and discuss the process.
  2. Teaming up with epileptologists at Littleton Adventist Hospital’s Epilepsy Monitoring Unit, we will conduct non-invasive testing to locate the cause of your seizures. These tests may include EEG, MRI, PET, or SPECT. If these test results are inconclusive or conflicting, we may recommend intracranial EEG monitoring to get a more detailed look at your brain activity.
  3. Once the cause and location of your seizures are determined, your neurosurgeon will determine the best surgical options for your specific needs and discuss those with you. He will present you with the benefits and risks of the surgery, the research supporting the surgery option, what you can expect as a result of your surgery, and any alternative approaches.

 

During epilepsy surgery

While every type of epilepsy surgery includes different surgical procedures, in general, you can expect the following during epilepsy surgery.

  • Close monitoring by a team of anesthesiologists, nurses, and surgeons to ensure your oxygen level, heart rate, and blood pressure are within safe ranges. The anesthesiologist also will ensure you remain asleep unless directed by the neurosurgeon to test movement or speech during surgery.
  • Depending on the type of surgery you have, your hair may be cut or partially shaved to lessen the occurrence of infection.
  • Based on the invasiveness of the procedure, seizure surgery can take several hours and varies based on the type of surgery.
  • For resection surgery, a craniotomy is performed, in which a small part of the skull is opened so the surgeon can access and remove the abnormal tissue causing the seizures. The skull is secured back in place after the tissue is removed.
  • During some epilepsy surgical procedures, EEG (electroencephalogram) monitoring may be done to pinpoint the exact location of the seizures. 

 

Learn more about the specifics of each epilepsy surgery.

 

After epilepsy surgery

Once your seizure surgery is complete, you will go into recovery. Based on the type of surgery you have, you will either recover in an intensive care unit or the neurosurgery or epilepsy unit.  

You may experience headaches and swelling of the head and/or face after epilepsy surgery. Medications will be administered to reduce these side effects.

Depending on the type of epilepsy surgery, patients spend 1-5 days in the hospital recovering after epilepsy surgery. Typically, most patients then go home to recover. During the next 4-6 weeks, you will gradually increase your activity. Depending on the type of epilepsy surgery you have, you may see immediate results or gradual results that can improve over months or years.