Epilepsy - Lifestyle Changes

Surgery

Surgical techniques to remove injured brain tissue may be appropriate for some patients with epilepsy. The surgeon's goal is to remove only the damaged tissue to prevent seizures and to avoid removing healthy brain tissue. The goal is to eliminate or at least reduce seizure activity while not causing any functional deficits, such as deterioration of speech or cognitive abilities.

Surgical techniques and pre-surgical planning for reaching these goals have improved significantly over the past decades due to advances in imaging and monitoring, new surgical techniques, and a better understanding of the brain and epilepsy.

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Evaluation to Determine Best Surgical Candidates

A number of tests using imaging and electroencephalography (EEG) can determine if surgery is an option:

• MRI of the brain is performed on all patients with epilepsy during the course of their illness. It often may identify an abnormality in brain tissue that is causing poorly controlled seizures.
• Ambulatory EEG monitoring involves wearing an EEG while taking part in everyday life. Video EEG monitoring involves being admitted to a special unit in the hospital and being observed while seizures occur. These tests are done to help locate the exact brain tissue that is triggering the epileptic event.
• Advanced imaging techniques can sometimes provide valuable additional information. They include functional magnetic resonance imaging (fMRI), positron emission tomography (PET), or single-photon emission computer tomography (SPECT) scans.

If the imaging tests indicate that more than one site is involved or their results conflict, then more invasive monitoring of the brain may be required, although the newer imaging tests are proving to be very accurate tools. If such tests pinpoint a specific area in the brain as the location for seizures, surgery is possible. The doctor will also examine the test results to avoid damaging areas of the brain necessary for the performance of vital functions.

While it is important to identify patients who are most likely to have successful outcomes from a medical standpoint, it is also important to identify a patient’s suitability for surgery based on psychosocial factors. Patients who have significant psychiatric disorders, or a history of not following prescribed medical treatment, may not be able to comply with the detailed presurgical and surgical protocols.