Surgery to Treat Epilepsy
Surgery is an option for a small number of patients whose epilepsy cannot be controlled with medication. A good candidate for surgery has seizures that always begin in the same cerebral location, which can be removed (resected) without creating deficits. Neurosurgeons generally avoid performing surgery in areas of the brain responsible for speech, hearing, and other important functions.
Types of Surgery to Treat Seizures
Lobectomy (lesionectomy) —This procedure removes a small part of the brain where seizures originate. It is appropriate only for partial seizures.
Multiple Subpial Transection—When seizures originate in part of the brain that cannot be removed, the surgeon may use this procedure, in which a series of small incisions are made that impede the spread of nerve activity.
Corpus Callosotomy—In this procedure, the surgeon severs the nerve fibers that connect the hemispheres of the brain to each other. This procedure is used to treat uncontrolled generalized tonic-clonic seizures, complex partial seizures with drop attacks, and other generalized seizures. Reduced seizure activity usually continues on one side of the brain.
Hemispherectomy—This procedure is a last resort in children with severe brain damage on one side and seizures that do not respond to medication. It involves removing the entire affected side of the brain. The remaining hemisphere develops language and motor areas for both sides of the body. With intense rehabilitation, many patients will lead functional lives.
Vagus Nerve Stimulator to Treat Epilepsy
This small device is implanted near the collarbone and attached to the vagus nerve, which connects the lower part of the brain to the heart, lungs, and gastrointestinal tract. It delivers small bursts of electrical energy to the brain at regular, pre-programmed intervals. In some patients, seizure frequency is reduced. Most patients remain on antiepileptic medication but may be able to reduce the dosage.
Research is being conducted to determine if deep brain stimulation (DBS) can help reduce seizures in patients who have epilepsy. This treatment, which is approved to treat other neurological disorders (e.g., essential tremor, Parkinson's disease), is not yet approved to treat epilepsy and is considered experimental in epilepsy patients. DBS is similar to vagus nerve stimulation (VNS), except the electrodes are placed deep in the brain (e.g., in the anterior nucleus of the thalamus). Deep brain stimulation, which has shown some promise in recent studies, is adjustable and reversible. Serious risks associated with DBS include bleeding in the brain.