Surgery for Epilepsy can be done for some people who have seizures that are not controlled by antiepileptic medications. The two main goals of Epilepsy surgery are:
Although some people do become seizure free after this surgery, not everyone does so. No surgery is without risk. To ensure that patients have the best chance for a good outcome, it is necessary to go through many vigorous and comprehensive tests.
The candidates for focal resective epilepsy surgery are people who:
If your seizure is coming from a small, single area of the brain which can be safely removed, focal resection may be performed to significantly reduce the seizure frequency and severity. Typical cases for this type of surgery are tumor resection, lesion resection, temporal lobe resection, carvenorma (abnormal blood vessel) resection, etc. To ensure that patients have the best chance for a good outcome, it is necesary to go through many vigorous and comprehensive tests.
An FDA approved neurostimulation therapy for refractory epilepsy. It is an adjunctive treatment for certain types of intractable epilepsy. It is designed to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve in the neck. These pulses are supplied by a device comparable to a pacemaker.
https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns
Another FDA approved neurostimulation therapy for an adult with a drug resistant focal epilepsy. It is designed to detect the seizure in the brain up to 2 focal areas by monitoring brain activity continuously from electrodes placed directly in the brain. It only delivers the stimulation automatically upon the detection of seizure or pre-seizure activity through the electrodes in order to stop or prevent the seizure.
The latest FA approved neurostimulation therapy for an adult with refractory focal epilepsy. It is designed to reduct the seizures by sending regular, mild pulses of electrical energy to the deep part of the brain (Thalamus) via electrodes directly placed on both sides of the Thalamus. This therapy is also used to treat other neurological conditions such as Parkinson's Disease, Essential Tremor, Dystonia, and Obsessive-Compulsive Disorder.
https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/deep-brain-stimulation-dbs
In order to decide if epilepsy surgery can help you to control your seizures, we need to do a number of tests. These tests help us locate where in the brain seizures may be starting. They also tell us if any part of the brain is abnormal in other ways. Each person is evaluated individually before we decide which tests you will need.
An EEG shows the brain's electrical activity and is the most common test used to help diagnose epilepsy. It can help pin point where your seizures are coming from. The technologist will place electrodes on your scalp in order to record brain activity. These will be secured to your scalp with removable adhesive, they must adhere to the skin so we can get an accurate reading.
Instrucciones de EEG (electroencefalograma)
Instrucciones para un EEG (electroencefalograma) Ambulatorio
We need to determine first whether or not your typical spells/events are truly epileptic seizures and if they are the right types of seizures for the epilepsy surgery.
Welcome to the Epilepsy Monitoring Unit (EMU)
Bienvenido a la Unidad de Monitoreo de Epilepsia (Siglas en inglés: EMU)
If we think you should be evaluated for possible surgery to help control your seizures, we bring you into the hospital for another EMU evaluation with additional tests. Ultimately, we need to capture 3-5 seizures to ensure all of your seizures are coming from one focus. Also, an ictal SPECT study may be done during this admission.
Epilepsy is hard to live with. Having epilepsy can cause many emotional problems for you and your family. Depression is more common in patients with epilepsy. Also, many of anti-epileptic medications can cause emotional problems, such as depression and suicidal thought. Epilepsy surgery can produce many changes in your life. Patients who undergo the surgical evaluation see our psychiatrist for an evaluation so that we can be sure they will get all the emotional support.
This test is performed by our contracted specialists at the Mind Clinic. This is located just north of the hospital. This test provides us even more information as to where your seizures are coming from by measuring magnetic fields created by the brains electrical currents You will need a MRI prior to this test, this was ordered previously as part of your original work up.
It is an evaluation of continuous video-EEG monitoring with intracranial electrodes instead of scalp electrodes. Some patients who are evaluated for epilepsy surgery with Phase I scalp video-EEG monitoring need to have more intensive video-EEG monitoring. This time we do an operation and put special electrodes into or onto the brain. Then we record seizures just as we did during the previous diagnostic and Phase I evaluation. This helps us to pinpoint more precisely the area where your seizures are starting within only a few millimeter radiuses. It also helps us learn if the seizures are coming from more than one area of the brain. During this invasive evaluation, we may perform the brain mapping with electrocorticography and stimulation which can tell us if the seizure focus has any important function such as controlling language, movement, or vision.
Two main types of intracranial EEG monitoring are Stereo Electroencephalogram, called sEEG and subdural/depth EEG.
If the patient is thought to have potential benefit from the surgery with previous tests, the next step is the actual epilepsy surgery. It takes a long time and lots of testing before we can reach this point. We are very careful because we want to offer patients the best possible chance for controlling the seizures. We also want to be as sure as possible that we can do the operation safely and not cause any harm. The chance for a good result depends on many things. The evaluation allows us to tell our patients how possible a good outcome is for them.
Surgery is not the end of the process. The recovery (Phase IV) is also an important time. We keep all our patients on antiepileptic medications for at least one to two years. We can never be absolutely sure that we have removed all the brain tissue that can cause seizures. However, the medications are usually able to work to control the seizures. The medications also help protect the brain as it heals. Many people never have another seizure after their operation. Some people have a few seizures immediately after the operation and then gain full control. Others will have fewer or less severe seizures. A few people see no improvement in their seizure control. There are no guarantees for this operation, but we try our best to give our patients the best chance possible. Whatever the outcome, we will continue to provide the care for our patients.
