EPILEPSY SURGERY- SIMPLE ANSWERS TO YOUR QUESTIONS

Epilepsy Surgery-Myths and Facts

Epilepsy surgery evaluation should be done for all patients with refractory epilepsy. It is extremely important to understand this, as some of the complex refractory epilepsies are completely curable with surgery. However, not everyone who has refractory epilepsy is eligible for surgery. We select a candidate with a clear focus of seizure origin, that is removable without a significant damage to the brain functions. Seizures with generalized onset or multifocal epilepsy cannot be managed with curative epilepsy surgery. Also, seizures with multifocal foci of onset, cannot be considered for surgery. Epilepsy surgery is not an option for a well controlled epilepsy, only for the sake of avoiding medications.

I have, here tried answer a few questions patients often ask, pertaining to epilepsy surgery.

“Doctor, I do not want to take medications, can I get rid of it with surgery?

I cannot take medications everyday” Mohit (name changed) was hopeful to get his epilepsy cured with surgery.

“Mohit, you have well controlled seizures on small dose of one medication, besides your condition is not surgically amenable…” I tried explaining him. But, many others do follow with similar doubts. Here are some questions frequently asked by People with Epilepsy (PWE).

“Doctor, My MRI brain is normal, then why do I still get seizures?”

Normal MRI doesn’t rule out seizure diagnosis. It can be normal even in patients who need multiple drugs for controlling epilepsy (refractory).

“Doctor, I will get my sister admitted for surgery, will she be seizure free within a week or so after admission? We are planning her wedding.”

Presurgical evaluation may take a month to few months, depending on the complexity of the cases. It is an exhaustive process and doctors try to be doubly sure before going ahead with surgery.

“Who can have surgery for epilepsy?”

There are two kinds of epilepsy, one with abnormality in a particular area of the brain(focal) and the other, in generalized area. Epilepsy surgery is predominantly for refractory epilepsy due to focal seizures.

“Doctor, what are the steps for having an epilepsy surgery?”

A right candidate is a patient who has frequent seizures even while on two or more medicines. Getting enrolled into an epilepsy surgical program is the first step. Your Epileptologist will explain you the details of subsequent journey and will help you throughout the process. Video EEG is a test where seizures and corresponding EEG activity is recorded in a laboratory and surgical suitability is assessed. Some patients may need advanced tests followed by PET scan, Neuropsychology tests. Each patient is thoroughly discussed by a team of Neurologists and Neurosurgeons before advocating surgery.

“Do we have remedy for the people who may not be fit for surgery despite having frequent seizures?”

Yes, there are two kinds of surgeries, one which completely cures and the other which provides some relief of symptoms. In addition, procedures like Vagus nerve stimulation, Responsive nerve stimulation, Ketogenic diet do help significantly in reducing the seizure burden. Trials are ongoing for novel therapeutic options such as DBS in refractory epilepsy.

Please contact your epileptologist if you think you have refractory epilepsy, for charting out the best solution for these difficult to control seizures.