Surgical Intervention

Surgery is highly effective in controlling seizures in appropriate cases. Patients who have repeated attacks of identical-looking seizures that arise from one part of the brain, or who have drop attacks, may be particularly good candidates. In order to find out if surgery is an option for treating an individual patient, a careful and thorough pre-surgical evaluation must be performed. This should be done at a comprehensive epilepsy program with extensive experience in the surgical treatment of epilepsy--one that performs these procedures regularly and frequently. The National Association of Epilepsy Centers recommends that a center perform at least 25 surgeries a year, on the average, to have adequate experience.

There are always risks with any treatment and especially with surgery. Only patients who cannot be controlled adequately and comfortably on antiepileptic medicine should be considered for surgery. Patients and their physicians must consider all factors before deciding on surgery. On the other hand, surgery should not be unduly delayed. It works very well and is very safe for many people.

The most common type of surgery performed for the treatment of epilepsy is the anterior temporal lobectomy. This removes the front part of the temporal lobe (there are two temporal lobes, one on each side of the brain, just above the ears). The reason it is the most common surgery performed is that most patients with epilepsy have complex partial seizures, and most cases of complex partial seizures are caused by a problem in the mesial (middle) and anterior (front) portion of the temporal lobe. In order to have the surgery, the evaluation must show that all the seizures are arising from this part of the brain. It is also important to be sure that the surgery will not cause speech defects or other serious neurological problems.

A second type of surgery, cutting the corpus callosum (a bridge of fibers connecting one side of the brain to the other), is now less frequently performed because of improved antiepileptic drugs and the development of the vagal nerve stimulator. This operation is used to treat patients who have drop attacks, either tonic or atonic. These seizures cause violent falls and often serious injury. The aim here is not so much complete control of the seizures, since the same patient often has other types of seizures as well, but a reduction in the frequency and severity of the falls and hopefully a reduction in generalized tonic-clonic seizures also.

If a person's seizures come from the cortex of the brain in the frontal or parietal area, or from certain parts of the temporal lobe, it may be possible to remove a part of the cortex safely without causing speech or motor problems. It is often necessary to place a group of electrodes (called an array) on the surface of the brain. By recording and stimulating various areas, the surgeons map which part of the brain should be removed and which parts cannot be touched.

Children who have very severe seizures coming from one side of the brain, and who already have paralysis of one side of the body, may benefit from a hemispherectomy, removal of all or most of one side of the brain. Surgery often results in complete control of seizures, a marked improvement in alertness, and an improvement in ability to learn.

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