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Surgical Procedures for Epilepsy

Surgery may help when:

  • Seizures happen in just one part of the brain or start in one part of the brain before spreading to the rest of the brain
  • Medicines do not help or they cause problems in your body
  • It removes a cause of the seizures, such as a brain tumor or too much fluid on the brain

Things you and your doctor should talk about before surgery are:

  • How often you have seizures and how bad they are
  • The part of the brain that has seizures and how much it impacts your everyday life

The main types are:

Lobectomy or Lesionectomy

This removes the part of the brain that makes the seizures. It is only done on people who have seizures that happen in one part of the brain. It often helps you have fewer seizures. It is very useful in people with some kinds of temporal lobe epilepsy.

For some lesions, interstitial laser ablation may be done. A tube is surgically placed and then a laser is used to destroy the lesion that causes the seizure.

Multiple Subpial Transection

This involves a series of cuts along the nerve path that the seizure impulses use to spread. It can prevent seizures from spreading to other parts of the brain. It leaves your normal abilities in place. It may be done alone or with a lobectomy. Alone, it is done in people whose seizures happen in a part of the brain that cannot be removed. This is done less often than a lobectomy.

Corpus Callosotomy

This surgery cuts the nerve between the right and left hemispheres of the brain to prevent seizures from spreading from one side to the other. It is often done in two steps. The first surgery partly separates the two halves, but it leaves some connections in place. If the seizures stop, the second surgery is not needed. If seizures keep occurring, a full separation may be done.

Corpus callosotomy is mostly done in children with severe seizures that start in one hemisphere of the brain and spread to the other. It can help prevent generalized seizures. The surgery does not prevent them in the side of the brain where they start.

Hemispherectomy

This surgery removes half of the brain's outer layer. It is often done in children whose epilepsy is not being helped by medicine and who have one of these health problems:

  • Rasmussen encephalitis
  • Other severe damage to one brain hemisphere

Your child will need help relearning basic tasks. After having this surgery, children often:

  • Have fewer or no seizures
  • Often heal well and can do normal tasks, but may have:
    • Weakness and loss of some movement on one side of the body
    • Loss of side vision

About half of children who have had this surgery need to keep taking medicine. Some can slowly be tapered off it if they do not have seizures for 12 months.

The chance of recovery is best in young children. That is why it is done early in a child’s life. It is almost never done in children over age 13.

Surgical Implants

There are two devices that are surgically placed under the skin. They help manage seizures in people whose symptoms are not helped by medicine.

  • Vagus nerve stimulator—gives short bursts of electricity to the brain through the vagus nerve in the neck
  • Responsive neurostimulator—notices electrical activity in the brain and gives electrical stimulation before seizure signs start
REFERENCES:

Bandt SK, Leuthardt EC. Minimally invasive neurosurgery for epilepsy using stereotactic MRI guidance. Neurosurg Clin N Am. 2016;27(1):51-58.

Epilepsy in adults. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115086/Epilepsy-in-adults. Updated November 9, 2018. Accessed March 27, 2019.

Epilepsy in children. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T900174/Epilepsy-in-children. Updated March 22, 2018. Accessed March 27, 2019.

Epilepsy information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Epilepsy-Information-Page. Updated June 18, 2018. Accessed March 26, 2019.

National Institute for Health and Clinical Excellence (NICE). The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. NICE 2012 Jan:CG137.

Treating seizures and epilepsy. Epilepsy Foundation website. Available at: http://www.epilepsy.com/learn/treating-seizures-and-epilepsy. Updated July 2013. Accessed March 28, 2019.

Last reviewed March 2019 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated: 3/28/2019