Children and adults with hard-to-manage seizures may be considered for epilepsy surgery if seizures remain uncontrolled after treatment with three or more anti-epileptic medications. In addition to possible impairment by the side effects of anti-epileptic medications, patients with uncontrolled, frequent seizures may experience:
- Physical consequences, such as falling into subway tracks, burns, or other self-injury during a seizure.
- Disruption of learning, attention, and memory
- Social consequences, including stigma, isolation, and employment limitations
Localizing the Seizures
The first step in determining whether neurosurgery would be an effective treatment for a child or adult involves extensive evaluation to localize the seizures (find out where they start) to determine whether the seizures begin in one small part of the brain that might be treated surgically. A comprehensive healthcare team consisting of neurologists, neurosurgeons, neuroradiologists, neuropsychologists, nurse specialists, language therapists, and occupational and physical therapists works together to find evidence that points to a particular part of the brain as the source of seizures in that child or adult.
Mapping Brain Function Prior to Surgery
After we determine the part of the brain responsible for the seizures, we must predict any major problems with speaking, understanding, or other abilities that could arise if we remove that part of the brain. We carefully tailor our neurosurgical approach to (1) obtain maximal seizure control and (2) minimize any dysfunction or difficulties afterward. Our aim, always, is to improve quality of life.
Some of the brain tissue that is responsible for seizures is abnormal tissue, such as scar tissue, tumor, or tissue that improperly became located in the brain during early development. The removal of abnormal tissue may control the seizures and will not cause any change in the person's functioning. However, in other cases, the brain tissue which gives rise to seizures is located near areas of the brain that are important for speaking, understanding, moving, remembering, or other important human abilities. During functional mapping, extensive careful testing helps us to determine the function of an area being considered for surgical removal. In some cases, we briefly interrupt the function of the part of the brain considered for surgical removal. We then make sure that the child or adult can still speak, understand, wiggle fingers, make puppets, cut sandwiches — do all the things he the patient can ordinarily do — even though we have interrupted the function of that part of the brain responsible for the seizures. We may do centimeter-by-centimeter functional mapping of the brain, using intracranial electrodes. In all cases, we want to be sure that any proposed surgery to control seizures will not create any long-term problems for the patient. All information gathered from functional mapping of the brain is shared with the patient and his or her family to help them make an informed choice regarding surgery.
What Can I Expect After Epilepsy Surgery?
Some patients are seizure-free after surgery; most have a great reduction in seizure frequency and severity. Many patients who do undergo surgery to remove that small part of their brain responsible for their seizures eventually improve in language or memory several months after the surgery. The improved seizure control allows adults to begin to pursue lifestyle possibilities, and allows children to maximize their development.
