Epilepsy surgery means a surgical procedure to eliminate or reduce your seizures. Surgery is only considered if you have refractory epilepsy, meaning you still have seizures despite the correct medications in the correct dosages. Before your doctor determines that you do not respond to medication, multiple medications will often be tried first, up to 3 or more. It is also important that your medications are taken as directed before you would be considered for surgical work up.
MUSC Neurosurgeon Dr. Steven Glazier, discusses Epilepsy Surgeries.
There are three different types of epilepsy surgery.
Resection: An example of this is an Anterior Temporal Lobectomy which involves taking out a portion of the brain called the temporal lobe, including the hippocampus and amygdala.
Disconnection: A functional hemispherectomy is an example of a disconnection, where trouble areas of the brain are disconnected from the good areas but everything is left in place.
Neuro-Modulation: The third type of epilepsy surgery is called neuro-modulation, which would include a vagus nerve stimulator. In this case, the brain is stimulated in a way that reduces your seizures. The type of surgery that will be offered depends on the results of an extensive pre-surgical evaluation.
The pre-surgical evaluation may include an inpatient video electroencephalography (vEEG), MRI, ictal and interictal SPECT scans, PET scans and possibly a MEG scan. These tests must agree that your seizures are coming from the same area in your brain. If the tests lead us to different areas of your brain, it is possible that your seizures are coming from more than one place, or we are unable to determine where your seizures are coming from and therefore cannot offer a surgical suggestion. Occasionally the work up will include placing electrodes on the surface of the brain. This is kind of like the inpatient video EEG, however the electrodes actually touch your brain instead of touching your scalp.