Adult Epilepsy Surgery
Dr. Andrew Romeo discusses epilepsy surgery, who is a candidate, and the various types of surgery available at Neurosurgery One in Denver, Colorado. Almost every adult with epilepsy who is experiencing seizures that are uncontrolled by medication is a candidate for surgery that will diminish or even stop all seizures. With advancements in research and technology, even patients with poorly localized seizures or who have had surgery in the past are candidates. Dr. Romeo is specially trained in functional neurosurgery, including epilepsy treatment, and collaborates with the Epilepsy Monitoring Unit team at Centura Health Littleton Adventist Hospital.
Transcript of video:
Andrew Romeo (Speaker) (00:06):
One of the reasons why I wanted to go into neurosurgery and particularly functional neurosurgery, is all the research and technology that is coming out in the field. It’s really, I think, going to revolutionize treatment of brain disorders over the next 10, 20 years. And there are already many companies out there who are working on new therapies that will take time to develop, but the number of companies working on these things are far more than has ever existed in the past, and are going to create therapies that have, in the past we’ve had no treatments for or certainly no surgical treatments. So it’s really exciting. It’s really field to be in at this time. So epilepsy is one of the most common neurologic disorders I think affects up to 1% of the general population. And a lot of those patients, up to 20 to 40% remain uncontrolled, meaning they continue to have seizures despite being on medication.
And those are the patients who really could potentially benefit from surgery. I think in the past that patients and even time oftentimes referring physicians, were afraid of surgery because it’s invasive, it has risk. There’s sort of a bad reputation sometimes in the community regarding brain surgery. But I think what patients need to understand is nowadays many of the surgeries for epilepsy are minimally invasive. They’re very well tolerated, they have very low complication rates, and there’s many new therapies now for epilepsy such that almost all patients who are uncontrolled on medications adult patients are off candidates for some kind of surgical therapy whether that is some kind of neurostimulator or a resection or a minimally invasive laser ablation, which is commonly done now for epilepsy. It all kind of depends on the type of epilepsy that the patient has, and there’s a big workup process involved in that. So that’s why I always encourage patients and physicians to come early, refer early to get started in that process. And I think that it’s oftentimes a question of what are the patients goals and what are their fears? I think that if they are truly afraid of brain surgery then there are options that don’t involve that, like vagal nerve simulators. But if their goal is really to be seizure free, then
I think that considering a brain operation a minimally invasive brain operation is something that it should be seriously looked into. So there are three types of neurostimulators for epilepsy. The vagus nerve stimulator, which involves a surgery to place the electrode on the vagus nerve in the neck and then the R NS system or NeuroPace device, which involves placing electrodes in the brain, which can detect seizures and then deliver stimulation in response to it. And long-term studies have really shown that and greater than 70% of patients get a lot of benefit from that device. And it’s also nice in that it can treat types of sies that otherwise prior had no surgical options. And then most recently the deep brain stimulator has been FDA approved for the treatment of epilepsy, which is similar to that of what’s used for movement disorders. It’s just in a slightly different place in the brain.