The main aim of Epilepsy treatment is to prevent seizures. If that’s not conceivable, then the goal is to at least lessen the number of seizures. Medication assists to permanently preventing seizures in many patients who have epilepsy.
Treatment of Epilepsy:
Medicines and diet changes are the most common epilepsy treatment. Multiple groups of antiepileptic medications are available for treating epilepsy which is decided to depend upon the age, type of seizure, general condition of the patient.
If your seizures are not controlled with 3 medicines together given at maximum tolerable doses for 3 months then your epilepsy is called Refractory Epilepsy. Now you are a candidate for Epilepsy surgery.
Those having uncontrolled fits are at high risk of harming themselves. If you belong to this group, epilepsy surgery can be the best option.
Investigations Required for Epilepsy Surgery:
You would be required to undergo some investigations to decide which epilepsy surgery is best for you.
- Video EEG – In this test, you would be kept in observation for 48 hrs to record your seizure activity and decide which area for your brain is starting the electrical activity.
- PET CT Scan
- MRI Brain with contrast
Conducting Epilepsy Surgery
With all the progress in this field, epilepsy surgery is now very safe and successful. It helps to prevent the possibility of uncontrolled fits. The neurosurgeon will either remove the lesion or cut the connection between the lesion and other areas of the brain.
In some cases, the neurosurgeon will implant electrodes in these areas to control the electrical activity. You will have epilepsy surgery under general anaesthesia. The duration will be around four hours, and you will be in the hospital for about a week.
Types of Epilepsy Surgery
There are different surgeries for treating epilepsy, depending on the location and size of the seizure focus. Most of it needs an opening in the skull bone or a craniotomy to expose the lesion in the brain. Hence, the neurosurgeon will do a craniotomy, before the epilepsy surgery.
Resection Surgery: It is the most common type of epilepsy surgery. During this surgery, your neurosurgeon will remove the area of your brain that causes fits. Your neurosurgeon will precisely locate this area, called the seizure focus, with the help of various tests.
They will make sure that there is no damage to critical areas of the brain. Critical areas are those that control memory, vision, speech, movements, etc. There are different types of resection surgeries:
- Lesionectomy– The neurosurgeon will remove the area of the lesion. It is helpful in those in whom the lesion is small. The main benefit is that the neurosurgeon removes only a tiny part of the brain. If the lesion is a small tumor or an aneurysm, removing it will provide long-lasting relief.
- Temporal lobe resection– You will have this epilepsy surgery if your lesion is the temporal lobe of the brain. It is very safe, with a success rate of more than 75%. You will be free from fits and will need only small doses of anti-epileptic medicines after this. In the rest 25%, there will be a big reduction in the frequency and severity.
- Frontal lobe resection– The frontal lobe of your brain controls your mood and impulses. It also controls the levels of your concentration, attention, organization, planning, etc.
- Having a frontal lobe resection will make almost 50% percent of people remain free of seizures. In about 30-40%, there will be a decrease in frequency. It helps to reduce the doses of medicines as well. This epilepsy surgery is now not performed due to severe side effects.
- Parietal and occipital lobe disconnection – These lobes are at the back of your brain. You will have this epilepsy surgery if the lesion is in any of these two lobes. In this surgery, the affected lobe is disconnected from the rest of the brain and seizure is controlled.
- Multiple subpial transections– If your seizure focus is in a critical area of your brain, removing it through epilepsy surgery is not possible. The aim then is to isolate the lesion and prevent the spread of impulses to other areas of the brain. Your neurosurgeon will make fine cuts in the gray matter of the brain surrounding the lesion. The gray matter lies below the pia mater, a membrane that surrounds the brain. These cuts prevent the transmission of impulses from the lesion.
- Hemispherectomy– It is most effective in children in whom the seizure focus is a large area in one side or hemisphere of the brain. During the surgery, the neurosurgeon will remove one half of the brain that acts as the focus of fits.
- Corpus Callosotomy– In this, the neurosurgeon will cut the connection between the two halves of the brain. You will have this if you have severe and uncontrolled fits that make you fall.
Other surgical treatments for Epilepsy:
Apart from resection surgeries, there are a few other procedures such as-
1 . DBS Surgery
In this, the neurosurgeon implants electrodes into areas that act as a focus. Then the neurosurgeon will place a stimulator under the skin in an area of your chest. The surgeon will then connect the electrodes to a stimulator.
The stimulator helps to control any abnormal impulses from the lesion. Whenever it observes the possibility of a fit, it sends a signal to the area to stop the impulses.
2. VagusNerve Stimulation Surgery (VNS)
In VNS, the neurosurgeon will place a small generator in the chest and connect it to the vagus nerve with the help of a ‘lead’. The generator will stimulate the vagus nerve at ‘set intervals’ and prevent seizures from occurring.
3. Stereotactic Radiosurgery
In this, low-intensity radiation beams target the lesion from many directions. It helps to focus precisely on the lesion during the procedure. There will be no damage to the normal areas of the brain.