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Epilepsy is a chronic neurological disorder that impacts approximately 50 million people globally. The majority of individuals with epilepsy can achieve reasonable seizure control through the use of anti-seizure medications (ASM). Unfortunately, however, around one-third of patients with epilepsy will continue to have seizures, even when treated with optimum ASM therapy. Surgery may provide substantial benefits to many potential candidates for epilepsy, leading to complete seizure freedom after surgery.
Synopsis
Understanding Drug-Resistant Epilepsy
A patient is considered to be medically resistant to seizure medication when seizures occur despite attempts at two or more medications that are suitable for the patient and one that the patient tolerates. The presence of seizures can substantially affect an individual's overall quality of life, education, employment, ability to live independently, mental health, and safety. For this reason, epilepsy surgery is not a last-resort treatment but rather a viable and effective treatment option for carefully screened individuals after medically appropriate treatment has failed.
What Is Epilepsy Surgery?
Epilepsy surgery involves identifying and treating the specific area of the brain where seizures originate. The goal is to disconnect or modify this region without affecting vital brain functions such as speech, memory, or movement.
Recent advancements in neuroimaging, brain mapping, and surgical techniques have made epilepsy surgery safer and far more efficient than previously.
Who Is a Candidate for Epilepsy Surgery?
Not every person with epilepsy requires or qualifies for surgery. Candidates are typically those who:
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Have seizures originating from a clearly identifiable zone/zones of the brain
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Have seizures that do not respond to medications
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Experience seizures that significantly affect daily life
A comprehensive pre-surgical evaluation is essential to determine suitability.
Pre-Surgical Evaluation: A Team-Based Approach
Before surgery, patients undergo detailed testing at a specialized epilepsy center, which may include:
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Video EEG monitoring to capture and analyze seizures
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MRI scans to detect structural abnormalities
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Epilepsy Protocol
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Functional imaging (PET, SPECT) to localize seizure activity
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Neuropsychological assessments to evaluate memory and cognition
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Brain mapping to protect critical functions / Invasive EEG called SEEG
These evaluations are conducted by a multidisciplinary team including neurologists, neurosurgeons, neuropsychologists, radiologists, and epilepsy specialists.
Types of Epilepsy Surgery
Surgery for seizures will depend on where they originated and what type they are.
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Resection: Removing the affected area of the brain that causes seizures (i.e., the temporal lobe), which is the most commonly performed in temporal lobe epilepsy.
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Laser Interstitial Thermal Therapy (LITT): A new type of surgery where we can destroy abnormal tissue using a laser (in this case, heat) with the least amount of damage to other parts of the brain and body.
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Disconnection Procedures: Procedures designed to interrupt the connection between areas in the brain where seizures originate to reduce how often they occur.
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Neuromodulation Therapies: Vagus Nerve Stimulation (VNS), Responsive Neurostimulation (RNS), and Deep Brain Stimulation (DBS) are all different types of procedures that modulate or control a person's neural network to help reduce the frequency of seizures when resection is not an option.
Benefits of Epilepsy Surgery
For well-selected patients, epilepsy surgery can be life-changing:
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Significant reduction or complete cessation of seizures
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Improved cognitive function and alertness
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Reduced dependence on medications
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Better quality of life and independence
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Enhanced safety and emotional well-being
Studies show that up to 70% of patients with temporal lobe epilepsy become seizure-free after surgery.
Risks and Recovery
Epilepsy surgery, like all surgeries involving the brain, poses risks, such as infection, bleeding, and neurologic changes that may last for a short period of time. With today's technology and highly trained doctors, these complications, although possible, are uncommon.
After having surgery, the length of time it takes for a person to recover will differ based on the procedure type. However, most patients will be able to return to their daily routines within a few weeks with the assistance of rehabilitation and aftercare.
Life After Epilepsy Surgery
Post-surgery, patients continue regular follow-ups and may need medications for a period of time. Over months and years, many are able to reduce or discontinue medications under medical supervision.
Beyond seizure control, patients often experience improvements in confidence, social engagement, and long-term health outcomes.
Breaking the Myths
Despite strong evidence, epilepsy surgery remains underutilized, often due to fear, misinformation, or delayed referral. Early evaluation at a specialized epilepsy center can make a critical difference.
A New Chapter of Hope
Epilepsy surgery is not about removing hope; it is about restoring it. A patient who continues to have uncontrolled seizures despite medication should contact their medical professional to discuss if surgical intervention would be appropriate for them. You can explore our experienced specialists and view detailed doctor profiles to find the right expert for your care, or visit Manipal Hospitals Old Airport Road to learn more about advanced treatment options available. Early evaluation saves years of suffering and can change lives.
FAQ's
Yes, when done safely under the care of a trained surgeon in a specialized epilepsy center, it has extremely low rates of serious complications. Surgical outcomes have also greatly improved through the use of advanced imaging techniques, brain mapping, and well-experienced surgical technicians.
Most patients with epilepsy who undergo epilepsy surgery have significant reductions in seizure frequency, and some could become completely seizure-free. The success of the surgery will depend on several factors, including the type of epilepsy, where the seizures begin, and other medical conditions that the patient may have.
Patients will not be required to stop taking their epilepsy medications immediately following surgery. The majority of patients will continue to take their medications for a while after surgery, and then, based on the patient's level of seizure control, the physician can taper the medications until they are no longer taking them, as per the physician's instructions.
Recovery varies by procedure. Minimally invasive surgeries may require only a short hospital stay, while open surgeries may take a few weeks. Most patients can return to daily activities gradually with medical guidance.
Epilepsy surgery may be considered for patients whose seizures are not controlled despite trying two or more anti-epileptic medications and who originate from a specific, identifiable area of the brain.
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