Epilepsy is one of the most common neurological disorders. In fact, 50 million people worldwide have epilepsy, according to the World Health Organization. According to the Epilepsy Foundation, about 3.4 million live in the United States.
At least 30% of people with epilepsy either don’t respond to treatment with medicine or suffer significant side effects. Those people may be eligible for alternative treatments, including epilepsy surgery, but fewer than 3% decide to undergo surgical treatment of epilepsy.
Epilepsy Surgery Candidates
People who experience a worse quality of life, frequent falls, loss of consciousness, or other harmful events due to frequent epileptic seizures should consider surgery. People who have taken two or more medicines with no improvement are potential candidates for epilepsy surgery.
Surgery shouldn’t be a last resort; anyone whose epilepsy isn’t controlled by medicine should be evaluated for surgery.
Several surgical treatments are available for epilepsy. The part of the brain where your seizures come from tells you and your doctors which type of surgery might be appropriate for you.
The only cure for epilepsy is to surgically remove the portion of the brain causing the seizures.
Surgical Options for Epilepsy
According to the Epilepsy Foundation, there are two traditional types of surgery for epilepsy: resection and disconnection. Resection surgery involves removing the part of the brain where the seizures originate. In disconnection surgery, the surgeon cuts some nerve pathways, which stops seizures from spreading.
One example of a type of resection is a temporal lobectomy. This is the most common and most successful surgery for epilepsy, where a portion of the brain’s temporal lobe is removed. About 60% to 70% of patients are seizure-free afterward, according to the Epilepsy Foundation, but may experience side effects, such as impaired memory.
Technological Advancements
Several new surgical techniques used by neurosurgeons to treat epilepsy have resulted in more effective and less invasive procedures and can produce better outcomes. These include:
Laser ablation
Laser ablation surgery, a minimally invasive procedure offered at UPMC, uses heat to deactivate the problematic part of the brain instead of surgically removing it. Patients often leave the hospital the same day.
This procedure is less invasive, has a shorter recovery time, and can reduce the chances of serious side effects compared to traditional surgery. A study by the American Epilepsy Society shows that people who underwent laser ablation had fewer negative effects on their memory than traditional surgery patients.
According to a study published in the journal Epilepsy & Behavior, 78% of people who had laser ablation surgery for epilepsy were seizure-free afterward. Many also were able to return to work and begin driving again.
ROSA
Robotic Stereotactic Assistance, or ROSA®, is a computer system that generates 3-D brain maps. ROSA’s robotic arm can then guide the precise placement of electrodes into the brain with epilepsy surgeries, such as SEEG (stereoelectroencephalogram), RNS (responsive neurostimulation), and DBS (deep brain stimulation).
In traditional epilepsy surgery, a portion of the skull is removed. With ROSA, small holes are made in the skull. ROSA offers greater accuracy, is less-invasive, and takes significantly less time than traditional surgery.
Neuromodulation
If resection, disconnection, or laser ablation are not options for you, there are neuromodulation options. These options include responsive neurostimulation (RNS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) to try to alleviate the seizures.
If you suffer from epileptic seizures and medicines haven’t been working for you, contact the Movement Disorders and Epilepsy Program at UPMC to schedule an evaluation.
Editor's Note: This article was originally published on , and was last reviewed on .