The Role of Neurosurgery in Epilepsy Management and Seizure Control

What is Epilepsy?

Epilepsy is a chronic brain condition in which nerve cells do not signal properly, resulting in recurring seizures. It is also known as a seizure disorder and can affect anyone, irrespective of gender or age.

A seizure is a medical condition in which a sudden and uncontrolled burst of electrical activity happens in the brain. It happens because of a temporary change in the electrical functioning of the brain.

What is Medically Intractable Epilepsy?

Intractable means not easily managed or relieved. Medically intractable epilepsy is also known as drug-resistant epilepsy, in which seizures can’t be completely controlled by medication.

What is Medically Refractory Epilepsy?

Medically refractory epilepsy is a condition that involves epilepsy that is resistant or unresponsive to medical treatment. In this case, you experience seizures even after using various medications and other treatment options.

Which Disease Can Be Treated with Epilepsy Surgery?

Following are the types of epilepsy that can be treated through surgery:

• Mesial temporal lobe epilepsy
• Neocortical epilepsy
• Focal epilepsy
• Hemispheric epilepsy
• Other severe and drug-resistant epilepsy

Causes and Symptoms of Epilepsy

There is no identifiable cause for epilepsy. However, there are certain risk factors, such as genetic influence, head trauma, injuries before birth, and developmental disorders.

Signs and symptoms of epilepsy depend on their type. Some of the symptoms include:

• Seizures
• Unusual sensations, emotions, or visual disturbances
• Temporary confusion
• Loss of consciousness
• Uncontrolled movements
• Stiff muscles

What are the indications for epilepsy surgery?

• Experiencing frequent seizures
• Failure of other treatments
• Side effects of anti-seizure medications
• Focal epilepsy
• Medication intolerance

What Are the Different Options for epilepsy surgery?

Epilepsy surgery is a brain surgery to reduce the frequency and severity of the seizures you’re experiencing. Surgical options for epilepsy management are considered when anti-seizure medications are not working well in one’s condition and if the seizures are severe and debilitating.

There are many types of surgical procedures available to manage seizures, including:

01. Surgical Resection

Resection surgery is the most common type of epilepsy surgery. In this surgery, neurosurgeons remove the specific area of the brain causing seizures to remove or treat epilepsy. There are several types of resection, such as:

• Lesionectomy

It is a common surgical procedure to remove a lesion, known as an abnormally functioning area in the brain. This procedure is performed under general anaesthesia and removes lesions such as tumours, cavernous haemangiomas, and arteriovenous malformations that can cause seizures. Most people find complete seizure control after this procedure.

• Lobectomy

Lobectomy is another operation that is done to manage and treat people who are dealing with epilepsy. This surgery is done on a person experiencing seizures from a well-defined area in the brain. During this surgery, the neurosurgeon removes the lobe where seizures begin.

02. Laser interstitial thermal therapy (LITT)

It is a minimally invasive surgical option that is used to treat medical conditions such as epilepsy. As the name suggests, it uses laser technology to target and destroy the abnormal brain tissues in the brain that lead to seizures.

03. Deep Brain Stimulation (DBS)

It is a medical technique that includes the implantation of electrodes in specific brain areas for the treatment of epilepsy. It is one of the types of neuromodulation therapy that is used together with the medication. This surgery includes the implantation of an electrode in the brain and the placement of a stimulator device under the skin in your chest. After this, the stimulator device gives signals to the electrode to receive signals from the nerve cells that trigger the seizures.

04. Hemispherectomy

‘Hemi’ means half, which represents the cerebral (brain) hemisphere, i.e., half of the brain. This surgical method is used to treat epilepsy when seizures are not controlled with medication. This procedure includes the removal of the entire cerebral hemisphere to stop the seizures. Hemispherectomy is generally done in children and occasionally in adults.

05. Corpus Callosotomy

Corpus callosotomy is a procedure that severs the corpus callosum, the bundle of nerve fibres connecting the brain’s two hemispheres. This procedure is typically performed in cases of severe epilepsy when seizures cannot be controlled by other means. It helps prevent seizures from spreading across the brain but does not eliminate them.

06. Amygdalohypocampectomy

It is a surgical intervention used to treat all drug-resistant epilepsy (DRE) that usually originates in the hippocampus and the temporal lobe. This surgery includes the partial resection and removal of a specific part of the brain, which is the amygdala and the hippocampus. It is considered a safe and effective procedure for managing temporal lobe epilepsy.

CONCLUSION

Epilepsy is a common neurological disorder that can lead to several seizures. If medications haven’t worked to control the seizures, doctors may opt for surgical options to treat and manage the epilepsy.

There are various surgical treatment options available to treat this chronic brain condition. Some of the options have been discussed in this blog, like lobectomy, hemispherectomy, and deep brain stimulation (DBS).

However, these surgical options depend on the severity and location of the seizures in the brain. It is important to consult your neurosurgeon before going through any examinations or treatments.