Epilepsy surgery refers to surgical interventions performed in cases of epilepsy that cannot be controlled by medication (drug-resistant epilepsy). The goal of the surgery is to remove or control the source of the seizures.

Who Is It Suitable For?

• Drug-Resistant Epilepsy: Epilepsy that cannot be controlled by at least two appropriate antiepileptic drugs.

• Focal Epilepsy: Seizures originating from a specific part of the brain.

• Neurological and Neuropsychological Evaluation: Suitable for patients where the chances of surgical success are high and the risks are acceptable.

Goals

• Completely Eliminate Seizures (Curative Surgery): The focus where seizures originate is entirely removed.

• Reduce Seizure Severity or Frequency (Palliative Surgery): Regulation of neural pathways to control seizures.

Types of Surgery

• Resective Surgery: Removal of brain tissue where seizures originate.

  • Temporal Lobectomy: The most common surgery, used for seizures originating in the temporal lobe.

  • Extra-temporal Resection: Performed for seizures originating outside the temporal lobe.

• Disconnection Surgery: Cutting off pathways in the brain that cause seizure spread.

  • Corpus Callosotomy: Prevents the spread of seizures between the two hemispheres of the brain.

  • Functional Hemispherectomy: Performed in children with severe, widespread seizures.

• Minimal Invasive Methods:

  • Laser Ablation: Using high heat under MRI guidance to destroy seizure foci.

  • Stereo-electroencephalography (SEEG)-Guided Surgery: Precisely locating seizure foci and performing targeted interventions.

• Neurostimulation Methods:

  • Vagus Nerve Stimulation (VNS): A device implanted in the neck to control seizures.

  • Deep Brain Stimulation (DBS): Electrical stimulation to specific regions of the brain.

Evaluation Process

Patients for epilepsy surgery undergo a comprehensive evaluation by a multidisciplinary team:

• Video-EEG: Used to identify the source of seizures.

• MRI Imaging: Detects structural anomalies in the brain.

• Neuropsychological Tests: Evaluates the cognitive effects of surgery.

• Functional Imaging (PET, SPECT): Provides additional information to detect seizure foci.

Risks and Complications

• Temporary or Permanent Neurological Deficits: Issues like memory problems or speech difficulties.

• Infection, Bleeding: General surgical risks.

• Inability to Fully Control Seizures: Especially in palliative surgeries.

Success Rates

• Temporal Lobectomy: In suitable patients, there is a 70-80% chance of complete seizure freedom.

• Palliative Methods: Significant reduction in seizure severity and frequency can be achieved.

Epilepsy surgery, when done with careful patient selection and detailed evaluation, offers an effective option for seizure control and improves quality of life.