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03 June 2002

Is surgery for epilepsy a viable option?

Specific surgical treatment for epilepsy has been rapidly developed over the last decade, and is now a well-established form of treatment for certain kinds of seizure.

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Specific surgical treatment for epilepsy has been rapidly developed over the last decade, and is now a well-established form of treatment for certain kinds of seizure.

In order for these operations to be successful, doctors need two essential pieces of information:
1. From where exactly in the brain do the seizures originate? Answering this question requires identification of the "seizure focus". Removal of this region will prevent the seizure from starting or spreading.
2. What are the normal functions of that part of the brain and the brain tissue close by? The neurosurgeon needs to remove epileptic brain, but at the same time must be very careful not to damage normal brain function.
 
Which patients qualify for surgery?
People with epilepsy who may benefit from surgery are most often those with complex partial seizures, originating in one of the temporal lobes, which are not controlled successfully with medications. Patients are screened extremely carefully to be sure that they are suitable candidates for surgery, and will certainly have already had routine EEGs and brain scans. Before surgery, they may need to undergo more specialised EEG monitoring to precisely identify the seizure focus, detailed MRI brain scans, and SPECT or PET scans which can confirm the site of seizure activity.

Surgery is usually avoided in regions of the brain with essential functions, such as control of movement or use of language. There are techniques to help identify exactly where these regions are in order to better avoid them during surgery.
 
The commonest operation is removal of the tip of the temporal lobe on one side - a so-called anterior temporal lobectomy. As with most other neurosurgery, this is a major procedure, done under full general anaesthetic and requiring a hospital stay of several days. Most surgeries are uncomplicated, and some 60-70% of patients can expect their seizures to be cured for good. Modern epilepsy surgery offers hope to many patients with previously intractable seizures.

 

 
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