13 Epilepsy Surgery
There are many types of epilepsy surgery. In broad terms, epilepsy surgery is when a neurosurgeon removes, disconnects or ablates the part of the brain involved in generating seizures. It can also mean a type of surgery where the surgeon inserts a device that stimulates part of the brain.
In the past, epilepsy surgery was felt to be a last resort after all other medical options have been exhausted. We now know that epilepsy surgery can be a worthwhile procedure for many people with epilepsy and should be considered as soon as the epilepsy becomes drug-resistant (after failing two antiseizure medicines at appropriate doses).
13.1 Goals of Epilepsy Surgery
Ultimately, the goal of any epilepsy surgery is to improve the quality of life of the patient. However, some types of epilepsy surgery have a curative intent, whereas other are meant to be palliative.
Curative epilepsy surgery is intended to completely stop seizures
A palliative epilepsy surgery is meant to significantly reduce the burden of seizures, but usually this type of surgery is not expected to completely stop seizures
Your team will review your particular options and the type of surgery with you.
13.2 Who is a good candidate for epilepsy surgery?
The bottom line is any patient who has treatment-resistant epilepsy should be referred for an evaluation for possible epilepsy surgery. Your doctors will take into account a number of factors when deciding whether epilepsy surgery is right for you.
When considering a curative approach, the first step is determining the type of epilepsy, and whether the seizures are coming from one particular area in the brain. A number of tests may be pursued (see next section), but your doctor will usually start with looking at EEG, MRI and the pattern of your seizures.
If seizures are indeed coming from one spot, the next step is to make sure that it would be safe to remove or disconnect that area of the brain without causing deficits.
13.3 Pursuing a presurgical evaluation does not mean you have to have surgery!
Just because you are having an evaluation does not mean you are committed to having surgery. Some patients may consider their options after an evaluation and decide not to move forward with epilepsy surgery or defer the decision to another time. You will have plenty of time to consider, but it is important to know your options!