Can Epilepsy be Treated by Surgery?

Epilepsy is a chronic neurological disorder characterized by recurrent seizures due to abnormal electrical activity of the brain. With time and medical advancements, there are treatments available for epilepsy. Though medications are known to control this disease, surgery is also preferred as an alternative under extreme conditions. 

Let’s try to understand this disease and have a look if surgery is an effective treatment for Epilepsy.

What do you mean by Epilepsy?

Epilepsy is a disorder of the central nervous system in which the patient’s brain activity becomes abnormal, causing seizures or periods of uncontrolled body movements. The brain continuously generates electrical signals that are transmitted throughout the body via neurotransmitters.

A burst of electrical signals in the brain causes imbalance and uncontrolled movement in specific parts of the body. Doctors usually recommend medicines, but if the drugs fail to control seizures, then surgery is considered the next step in the course of treatment. Let us have a look at the goals of performing an operation.

What are the Goals of Epilepsy Surgery?

About 30% of patients continue to suffer from Epilepsy even after taking prescribed medications. Some even go through side effects of the drugs, making it difficult for them to rely solely on prescriptions.

In such cases, doctors take the next step of operating on the brain. For surgery to be performed in Epilepsy, it is imperative that the imbalance in signals originate from one particular point in the brain known as the focus of the seizure.

Surgery aims to counter seizures in these three ways:-

• Remove the focus of the seizure.
• Disrupt the nervous pathways that impulses take.
• Implant a device to control seizures.

Types of Surgery

The type of surgery depends on the seizure focus and is broadly classified as follows:-

Type of Surgery	Target Area	Procedure
Lobe Resection.	Temporal Lobe	Removing brain tissue within the temporal lobe.
Lesionectomy.	Brain Lesions like a Tumor or malformed blood vessel.	Removing brain lesions, for example, a tumors or blood vessel.
Corpus Callosotomy.	Corpus Callosum	Removing the nerves that connect both halves of the brain to avoid the spread of seizures.
Functional Hemispherectomy.	Entire hemisphere (Half of your brain)	To disconnect one hemisphere from the rest of the brain.
Multiple Subpial Transection (MST).	Series of shallow cuts in brain tissue	Surgeons transect the brain tissue to interrupt the flow of seizures.
Vagus Nerve Stimulation (VNS).	Vagus Nerve	Device is put under the vagus nerve to control the jolt.
Responsive Neurostimulation Device (RNS).	Doctors put a neurostimulator in the brain.	Neurostimulators detect any abnormal activity in the brain and send signals to stop them.
Deep Brain Stimulation.	A specific area of the brain	Put electrodes to stimulate the brain and control seizures.

Prerequisites for Epilepsy Surgery

Though surgery is an effective way to control Epilepsy, it is not the first line of treatment. Below we have listed the prerequisites required for a surgery to be performed:-

• The seizure focus is identifiable, and seizures start from one specific area of the brain.
• The area doesn’t control any necessary functions like speech, movement, etc.
• Administering medications have been unsuccessful in controlling seizures.
• Medications have caused severe side effects.
• Seizures are incapacitating.

Risks of Epilepsy Surgery

As with every operation, there are a few risks associated with epilepsy surgical treatment.

• Infection & Bleeding

The basic risk associated with any surgery is infection and bleeding, as well as risks associated with the use of anaesthesia.

• Return of Seizures

Another major problem with epilepsy surgery is the risk of return of seizures. In such a case, the doctor may choose to operate and completely remove the remaining part of the seizure’s focus.

• Loss of a Vital Function

Operating on the brain is a gamble in parts since it may jeopardise any major functions of the brain by creating new pathways for neurotransmission.

Conclusion

As we read above, surgery is an effective treatment for Epilepsy. Patients are advised to take medications after surgery and visit the doctor for regular checkups. While some patients may have a few epileptic seizures even after the surgical operation, many of them recover completely. Even in those where seizures happen after surgery, they are now much more amenable to control by one or a few medicines and the quality of life improves.

Dr. Sushma Sharma

HOD & Sr. Consultant – Neurology

Metro Heart Institute with Multispecialty Faridabad