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Surgical Treatment for Epilepsy

Epilepsy surgery can be a safe and effective treatment option when more than two anti-seizure medication trials fail to control your seizures. It’s important to be evaluated at an epilepsy center to see if you’re a candidate for epilepsy surgery if anti-seizure medications do not control your seizures.


Types of Surgical Options:

Removal of Seizures Focus

Focal resection procedure involves removing the portion of the brain where seizures originate. For example, neurosurgeons remove a portion of the temporal lobe in patients with temporal lobe epilepsy. 

Most patients can go home the day after treatment and can quickly return to normal activities. The main benefits of less invasive surgery are faster recovery time, shorter hospital stays, minimal post-procedure pain, and little or no hair removal at the treatment site.


Neuromodulation

Vagus nerve stimulation (VNS) has been approved by the U.S. Food and Drug Administration (FDA) as an add-on therapy for adults and children 4 years and older. It is approved to treat focal or partial seizures that do not respond to seizure medications. This is called drug-resistant epilepsy or refractory epilepsy. Vagus nerve stimulation (VNS) may prevent or lessen seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. The therapy consists of a device that is implanted under the skin in the left chest area. An electrode or wire is attached to the generator device and placed under the skin. The wire is attached or wound around the vagus nerve in the neck The device is programmed to give stimulation at regular intervals, alternating between periods of stimulation and no stimulation. Research shows that about 30 percent of people treated with VNS experience major improvement in seizure control. Another 30 percent experience some improvement. Most patients who undergo VNS must continue epilepsy drugs, but some can reduce their dosage. VNS is an attractive option when a seizure focus cannot be identified or when there are more than two seizure foci.

RNS (Responsive Neuro Stimulation) is a new approach to treating medically uncontrolled partial-onset seizures. The system is approved by the FDA as an adjunctive treatment for adults with medically refractory partial seizures. The RNS System provides responsive neurostimulation, automatically monitoring brain signals and providing stimulation to abnormal electrical brain events just when it is needed. RNS treatment is available to people who cannot have respective surgery or laser ablation. RNS may be an option for many people previously not considered candidates for epilepsy surgery, such as those with a seizure focus in a critical part of the brain (near speech, vision, or movement centers) or those with more than one seizure focus. This is because RNS therapy does not remove brain tissue, and the leads can be placed in or on more than one brain region. The RNS Neurostimulator is placed under the scalp and within the skull by a surgeon. One or two leads are then placed at the seizure target and connected to the neurostimulator. After the incision heals, the neurostimulator should not be noticeable to others. The neurostimulator continuously monitors the brain’s activity and is programmed by the epilepsy doctor to detect and record specific patterns that could lead to a seizure. When these patterns are detected, the neurostimulator responds with brief pulses of stimulation intended to disrupt the abnormal brain activity before a seizure occurs. Detection and stimulation settings are individualized for each patient’s patterns so that the stimulation is not felt. In addition, each patient gets a take-home monitor so that brain activity data can be sent to the epilepsy doctor between office visits.

Deep Brain Stimulation (DBS) Therapy is designed to change how brain cells or networks work by giving electrical stimulation to brain areas involved in seizures. A small neurostimulator is surgically placed under the skin in the chest or abdomen to deliver therapy. The device sends electrical pulses through thin, insulated wires called leads that are placed in a specific area of your brain. High-frequency stimulation undetectable by the patient stops developing seizures from manifesting and spreading. The treatment leads to a reduction in seizures and this reduction is progressive, meaning that even after five years of DBS, there is still ongoing improvement.

Hemispherectomy is a treatment we don’t often recommend. It involves removing almost all of one hemisphere, or side, of the brain. It can be a very successful procedure, but it is never the first option for treatment. We usually only perform it in newborns and children whose brains are capable of compensating for the removal of so much tissue.