Epilepsy Surgery

Most underlying causes for epilepsy have a strong genetic component such as a tendency to having seizures passed down from parents, or genetic diseases such as neurofibromatosis.

Other reasons include structural brain changes following a stroke, an illness such as meningitis, or a head trauma.

Diagnosis

Epilepsy is hard to diagnose and there are a variety of tests which may be employed in order to do so:

• Electroencephalography (EEG), which is neuroimaging technique that measures the electrical activity in your brain. Through this, any irregularities in your brain waves can be observed.

• Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan are also neuroimaging methods which allow doctors to look at the structure of your brain and allow them to detect tumours, lesions or scarring.

• Blood tests to rule out genetic conditions or infections.

• Neuropsychological tests to measure your cognitive abilities and help pinpoint the type of epilepsy your have or where in the brain the damage might have occurred.

How does the procedure work?

During the surgery you will be placed under general anaesthesia. The surgeon starts by making small incisions in your scalp and then access the brain area to be removed after making an opening in your skull. The different types of surgeries include:

• Temporal lobectomy: This is the most common type of surgery, where the brain tissue in the temporal lobe causing the epilepsy is taken out. It commonly involves removing the anterior thalamus, amygdala and hippocampus.

• Leisonectomy: Where brain tissue damaged by injury or tumors is removed.

• Extratemporal lobectomy: Where epileptic brain tissue associated with any other part of the brain is cut away.

• Hemispherectomy: The surgery involves removing the outer layer of an entire hemisphere of the brain. This is a highly uncommon procedure and is only performed when one side of the brain has undergone severe damage. A hemispherectomy is carried out mostly on younger children.

• Corpus callosotomy: In this surgery the corpus callosum, which is a set of nerve fibres connecting the right hemisphere of the brain to the left is cut. This helps avoiding the spread of the seizure to both hemispheres.

• Multiple subpial transection: If seizures arise from within an area in the brain that is hard to access or vital for functioning, a multiple subpial transection is performed. This surgery is carried out by severing nerve fibers in the layer below the pia mater (the last and innermost layer of the meninges), on the outer layer of the brain area identified as the source.

At the end of each of the surgeries, the skull is fixed back into its original position and the scalp is then stitched.

What should I expect from this procedure?

Epilepsy surgery should not be your first option, but an option only after antiepileptic drugs (AED) do not help in alleviating your symptoms. If both surgery and drugs are not viable options for you, then vagus nerve stimulation or deep brain stimulation could be alternative treatments to try out.

Epilepsy surgery is a major step and involves a great deal of recovery time, and comes with major risk factors that may persist for a long time. On the other hand, if all goes well with the surgery and if all post-op instructions are followed, most patients report being seizure-free within time.

What lifestyle changes are involved when undergoing epilepsy surgery?

Lifestyle changes are an integral part of any treatment or recovery. It is important to make sure you are taking your medication correctly, keep frequently going to your doctor and checking your dosages. Keep up a healthy routine, complete with a wholesome diet, exercise and rest. Be sure to take care of your mental health, and always ask loved ones for assistance or join support groups.