Medication can help to control seizures in many people with epilepsy, but it doesn’t work for everyone. About a third of people with epilepsy will reach a point when medication is no longer effective. Surgery may be the best treatment option.
Top Notch Comprehensive Care
The goal of the epilepsy specialists at Ascension Seton is to help people better control or cure their epilepsy. Surgical options are available for cases in which medication doesn’t work. Our team of neurologists and neurosurgeons are highly trained to perform cutting-edge surgery.
A thorough evaluation and testing is the first step. The evaluation locates the part of the brain where the seizures originate. Testing includes an MRI of the brain to look for abnormalities, an EEG to locate the source of seizures and a study of cognitive function. Other exams may also help to evaluate the particular case of epilepsy.
Candidates for epilepsy surgery include:
- People for whom medication doesn’t work
- People who have major side effects from medication
- The part of the brain where seizures start can be removed without causing neurological problems
RNS (Responsive Neurostimulation)
Responsive neurostimulation is a technology designed to decrease the frequency of seizures in people with partial onset seizure disorder. This treatment uses a device to monitor brain activity. The device works to detect and offset abnormal brain activity to stop seizures before they occur, similar to the way a pacemaker controls a person’s heartbeat.
Temporal lobe epilepsy is a common form of epilepsy that is usually resistant to medications. A temporal lobectomy removes a small portion of the temporal lobe. It is one of the most common surgeries for epilepsy. Only abnormal tissue is removed, so brain areas vital to functioning are left untouched.
This surgery removes parts of the hippocampus and amygdalae, which are located in the center of the brain. The surgery is minimally invasive. This procedure is becoming a more common way to treat temporal lobe epilepsy.
Visualase Thermal Ablation Surgery
Stereotactic laser ablation uses light energy to destroy abnormal tissue that causes seizures. This minimally invasive procedure is guided by MRI imagery, so it’s very precise. Laser surgery is becoming an alternative to conventional epilepsy surgery. A small hole is drilled into the skull and a laser applicator is inserted. Energy is delivered to the target area using a laser probe. This raises the temperature in the area, which destroys unwanted tissue.
Customized (Tailored) Neocortical Resection
Seizures can come from anywhere in the cortex of the brain. Seizure history, EEG and seizure behavior may point to an area or side of the brain, and the individual may be offered an intracranial electrode study or operation. This is sometimes referred to as a grid study. In the operation, special electrodes are directly placed on the brain’s surface. The wires from the electrodes are brought out through the scalp. The individual is then transferred from the operating room to the Intensive Care Unit (ICU). The wires are connected to an EEG machine.
The brain is studied to determine where the seizure begins. This type of EEG offers the most precise way to locate the source of a seizure. The area around the seizure is mapped so the surgeon knows where vital brain functions happen.
Sometimes the area where the seizures begin can be safely removed. If this is the case, a second operation will remove affected brain tissue and seizures will stop. If tissue cannot be safely removed, a different procedure may be recommended.
Structural brain abnormalities can cause seizures and epilepsy. Abnormal structures in the brain are called lesions, and can frequently be found through brain scans. Often, the lesion can be removed, causing the seizures to stop. By removing the lesion, doctors are able to provide a diagnosis as well.
The corpus callosum is a band of nerves that connect the brain’s two halves (hemispheres). For people with epilepsy, seizures can spread across these nerves. A corpus callosotomy is offered to people who have generalized epilepsy, where the seizure is not located in a specific area. The procedure cuts the nerves, which stops seizures from spreading across the brain. Although this surgery won’t stop seizures from happening, it will make them less severe.
In this surgery, one side of the brain is fully or partially removed. It is disconnected from the other side of the brain. People born with abnormalities or who suffered brain injuries at an early age may be candidates for this surgery.
Multiple Subpial Transection
Sometimes seizures occur in parts of the brain that can’t be removed safely. This can happen if the brain region where the seizure occurs is responsible for vital functions like movement or speech. In these cases, multiple subpial transections are performed. A surgeon makes a shallow cut to disconnect nerve fibers in the brain. These nerve fibers spread the seizure from one side of the brain to the other. Once cut, seizures lessen but are not cured.
VNS (Vagal Nerve Stimulation)
Vagal nerve stimulation is an option when epilepsy can’t be treated surgically. This outpatient procedure won’t cure epilepsy but can reduce the frequency and intensity of seizures. The vagus nerve passes from the brain into the neck. In this surgery, a small incision is made in the neck so small can be placed on the nerve. Another incision is made in the collar bone, where a device is placed that sends regular electrical impulses to the brain. The VNS device is sometimes called a pacemaker for the brain.
CyberKnife Stereotactic Radiosurgery
CyberKnife stereotactic radiosurgery is a popular method to treat lesions in the brain. It works by targeting a high dose of radiation on a small area of the brain. The procedure can be an effective treatment for people for whom brain surgery isn’t an option. The procedure has been successfully used to treat tumors and abnormalities that cause seizures.