Treatment Options: Surgery
When antiepileptic drugs fail to control or substantially reduce seizures, surgery on the brain may be considered. Although some of the techniques are recent, surgical removal of seizure-producing areas of the brain has been an accepted form of treatment for more than 50 years. Most surgical patients are adults who have fought long and unsuccessful battles for seizure control. However, children with severe seizures are also being treated with surgery.
Brain surgery can be a successful way of treating epilepsy. Surgery is most likely to be considered when someone with epilepsy:
Has documented epileptic seizures and not pseudoseizures.
Has already tried the standard medicines without success (or has bad reactions to them).
Has seizures that always start in just one part of the brain.
Has seizures in a part of the brain that can be removed without damaging important things like speech, memory or eyesight.
Surgery for epilepsy is a delicate, complicated operation. It must be performed by a skilled, experienced surgical team. It is usually done at special medical centers that treat patients with epilepsy rather than at local hospitals. In addition to operations that remove a small part of the brain where seizures begin, other procedures may be done to interrupt the spread of electrical energy in the brain.
People who are going to have epilepsy surgery may have several special tests first. In some cases, electrodes have to be implanted in a separate operation to locate seizure sites deep in the brain. Sometimes these tests take days or even weeks to complete.
In some cases, the patient may be awake during part of the operation. This is not usually the case with small children. This is possible because the brain does not feel pain. Having the patient awake helps the doctors make sure that important parts of the brain are not damaged.
Afterwards, some seizure medications may have to be continued, usually for a year or two. Then, if no further seizures occur, the medicine may be slowly withdrawn. At this point, chances of living free of seizures and free of medication are good. However, many people will have to continue with medication and some do not benefit from surgery.
Even though epilepsy surgery has been in use for the last 50 years, it is still often considered a last resort. That perception is steadily changing.