What're the surgeries available to cure epilepsy?

Surgery has become a safer option in recent years because of advances in brain imaging and surgical techniques that make it possible to pinpoint the area of the brain where the seizures occur, and to remove just that area. The goal is to remove just enough of the damaged brain tissue to stop seizures. The most common form of epilepsy involves seizures that begin in the brain's temporal lobes, the sections along the sides of the woman’s brain. This type of epilepsy is the hardest to control with medication, but it is the type most likely to respond to surgical treatment.

The first step is to pinpoint the area of the brain where the abnormal electrical activity happens. This area can be found by long-term EEG monitoring with help from MRI and PET scans. Functional MRI can be used to determine whether the affected brain cells perform a vital function. Surgeons avoid operating on areas of the brain that control speech, language, hearing, and other vital functions.

Temporal lobectomy. The most common surgical procedure for epilepsy is temporal lobectomy, which is performed when epilepsy occurs in the temporal lobe. (Surgery is not as successful in epilepsies that occur in the frontal lobe.) It involves removing small portions from the hippocampus, a portion of the brain that is involved in memory processing and is part of the limbic system, an emotional center. A typical candidates for this surgery is an adolescent or the womanng adult with complex partial seizures that began between age five and 10, and although the seizures were often in remission, they eventually became intractable. The womanng children may be more difficult candidates because they often have injured areas outside the temporal lobes. Nevertheless, surgery can be very successful in many children, even if more than one area is involved.

Lesionectomy. Another most frequently used type of surgery for epilepsy aims to remove a seizure focus; a small area of abnormality in the brain where seizures originate. The operation removes the abnormal area of brain that is causing the epilepsy but leaves the parts that are still serving useful purposes. If the part of the brain causing the seizures is in the temporal lobe, the surgeon will perform a type of focal resection called a ‘temporal resection’. If the part of the brain causing the seizures is in one of the other lobes, then the operation will be called an "extratemporal resection".

Lobectomy. A lobectomy or lobe removal takes away a larger area of the brain but is still intended to remove only the area of seizure focus. Temporal lobectomy is the most frequently performed surgical procedure to treat epilepsy. Removal of the temporal lobe stops temporal lobe epilepsy about 90% of the time.

Corpus callosotomy. Corpus callosotomy is is considered for children who have many different seizure types, including ‘drop attacks’. Drop attacks occur when the child suddenly drops to the ground, either stiff or floppy and may harm themselves. This operation disconnects the two sides of the brain from each other but no tissue is removed. The aim of this procedure is to stop these ‘drop attacks’ but it will not affect the other seizure types.

Hemispherectomy. This operation disconnects or removes one half of the brain from the other. Children who may benefit from this procedure usually have a long history of weakness down one side of the body. This is usually the result of severe damage to the opposite side of the brain, which may have been present from birth. The child’s general development may have been slow but normal. If the seizures are considered to arise from the damaged part of the brain, it is removed or disconnected to stop the seizures. This may not lead to any further weakness as the brain has usually reorganised other functions to the unaffected side.

More information on epilepsy (seizures)