Surgery for epilepsy is brain surgery. There are various types of epilepsy surgery:
- Lobectomy removes all or part of one of the lobes of the brain where seizures begin. A temporal lobectomy, the most common type of surgery, removes seizure-generating tissue from the temporal lobe. Seizures with origins in other areas of the brain may also be treated with this surgery.
- Corpus Callosotomy cuts the connections between the two brain hemispheres to prevent seizures beginning on one side from spreading to the other. This procedure is most often performed when a patient experiences uncontrolled drop seizures or severe generalized tonic-clonic seizures.
- Hemispherectomy removes all or almost all of one hemisphere of the brain and is only performed when there is a severely diseased, seizure-causing hemisphere.
- In Laser Ablation a thin, laser-tipped probe is inserted into the brain through a tiny hole in the skull. The surgeon views real-time MRI images of the process and is able to target the specific lesion with minimal exposure to surrounding tissue. The heat generated by the light from the laser destroys the targeted tissue. Patients who undergo the laser treatment typically need to stay only 1 day at the hospital, endure little-to-no pain, and require only a single stitch to close the incision made in the skull. Recovery is rapid.
- Responsive Neurostimulation (RNS)
The vagus nerve stimulator, which controls seizures by sending electrical pulses to the vagus nerve, can be implanted on an outpatient basis using a single incision. Wake Forest Baptist was instrumental in the nine-year research effort leading to the device's approval and was the first hospital in the United States to implant the device in a patient.
Candidates for Epilepsy Surgery
For patients who do not respond to medication, epilepsy surgery can dramatically improve quality of life.
In order to determine if a patient with epilepsy is a candidate for surgery, tests need to be conducted to help pinpoint where in the brain the seizures originate. Patients at Wake Forest Baptist undergo monitoring in our six-bed Epilepsy Monitoring Unit where the following tests may be performed:
- Video and electroencephalographic (EEG) monitoring
- Resonance imaging (MRI)
- Functional magnetic resonance imaging (fMRI)
- Positron emission tomography (PET)
- SISCOM
- Neuropsychological tests
- Magnetoencephalography (MEG)
Benefits of Epilepsy Surgery
Once the seizure focus is located, a patient may be a candidate for surgical resection. Surgical removal of the epileptic focus has been successful and safe in adults and children of all ages. These surgical approaches are especially beneficial for children with epilepsy, who can be spared the learning and developmental problems associated with poor seizure control.
In the first randomized, controlled trial of surgery for epilepsy, researchers found that surgery is far more effective than medical therapy for treating drug-resistant epilepsy (New England Journal of Medicine, August 2, 2001). Complete seizure control is achieved in 70 to 80 percent of patients; another 10 to 15 percent have a significant reduction in frequency and severity of seizures.
Wake Forest Baptist Approach
At Wake Forest Baptist, neurosurgeons Daniel Couture, MD, and Adrian Laxton, MD, are world leaders in using laser therapy to treat epilepsy. The Comprehensive Epilepsy Center is internationally recognized for the diagnosis and effective treatment of epilepsy. From a state-of-the-art epilepsy monitoring unit to advanced diagnostic mapping, our team of multidisciplinary epilepsy specialists is fully trained and experienced in treating patients of all ages.
