What are the symptoms to undergo epilepsy surgery?

Epilepsy surgery is a treatment option for epilepsy, used when other treatments, like medications, have not effectively controlled seizures.

• Seizures:

• The hallmark symptom of epilepsy is recurrent seizures, which can manifest in various ways, including convulsions, staring spells, unusual sensations, or sudden loss of consciousness.

• Aura:

• An “aura” is a warning sign that a seizure is about to occur experienced by some individuals.
• Auras can manifest as sensory disturbances, emotions, or unusual feelings.

• Automatisms:

• In some seizures, individuals may perform repetitive, involuntary movements known as automatisms, such as lip-smacking, picking at clothes, or hand rubbing.

• Loss of consciousness:

• Many seizures involve a temporary loss of consciousness, which can be brief or prolonged.

• Confusion and memory impairment:

• After a seizure, individuals may experience confusion, memory loss, or difficulty recalling the events leading up to the seizure.

• Tonic-clonic movements:

• Tonic-clonic seizures, or grand mal seizures, involve stiffening (tonic phase) followed by the limbs’ rhythmic jerking (clonic phase).

Epilepsy is a spectrum of disorders with varying symptoms, depending on the affected brain part and underlying cause. Epilepsy surgery is considered when seizures are not well-controlled with medications, and the seizure focus can be identified and targeted. It is not a cause or symptom of epilepsy but a therapeutic option for some instances of drug-resistant epilepsy.

What are the types of epilepsy surgery?

• Temporal lobectomy: 

• Involves the removal of a portion of the temporal lobe, often the hippocampus.
•  Commonly performed for individuals with temporal lobe epilepsy.

• Frontal lobectomy:

• An incision is made on the frontal lobe, and part is removed.
• Suitable for patients with seizures originating in the frontal lobe.

• Hemispherectomy:

• Removal or disconnection of one cerebral hemisphere.
• Typically considered for severe cases, especially in children.

• Corpus callosotomy:

• Severs the corpus callosum, the bundle of nerves connecting the brain’s hemispheres.
• Used to prevent the spread of seizures between hemispheres.

• Multiple subpial transection(MST):

• Disrupts the horizontal connections between neurons without removing brain tissue.
• Preserves function while reducing seizure activity.

• Vagus nerve stimulation(VNS):

• Vascular nerve stimulation by implanting a device.
• It may be considered when resective surgery is not feasible.

• Responsive neurostimulation(RNS):

• Involves the implantation of a device that monitors brain activity and delivers targeted stimulation to prevent seizures.

Epilepsy surgery is typically considered after other treatment options, such as antiepileptic medications, have proven ineffective in controlling seizures. A thorough pre-surgical evaluation, including EEG monitoring, MRI, PET, SPECT, and neuropsychological assessments, helps identify the seizure focus and assess the potential impact on cognitive functions. The decision to undergo surgery is collaboratively made between the patient, neurologists, neurosurgeons, and other healthcare professionals, considering both benefits and risks. Post-operative care includes monitoring, rehabilitation, and medication adjustments.

Individuals who are eligible for epilepsy surgery:

• Failed medication trials:

• Candidates have typically tried and failed multiple anti-seizure medications.

• Identifiable seizure focus:

• Various diagnostic tests can pinpoint a clear focus or origin of seizures.

• Preservation of function:

• The surgery should not impair critical brain functions, and potential benefits must outweigh the risks.

• Seizure localization:

• Successful candidates often undergo detailed pre-surgical evaluations, including video EEG, MRI, PET scans, and neuropsychological testing to pinpoint the seizure focus.

Evaluation process:

• Pre-surgical evaluation:

• Video EEG monitoring to record seizures.
• Neuroimaging (MRI, PET) to identify structural abnormalities.
• Neuropsychological testing to assess cognitive functions.
• Functional MRI (fMRI) and WADA tests to map language and memory areas.

• Multidisciplinary team:

• Evaluation involves a team of specialists, including neurologists, neurosurgeons, neuropsychologists, and other healthcare professionals.

• Decision making:

• The team assesses the risks and benefits of surgery based on the individual’s case.

Post-surgical care:

• Monitoring:

• Intensive monitoring to assess seizure control and any potential side effects.

• Rehabilitation:

• Rehabilitation may be necessary, especially for cognitive or motor deficits.

• Medication adjustment:

• Medications may need to be adjusted post-surgery.

• Follow-up evaluation:

• Regular follow-ups with neurologists and other specialists to monitor long-term outcomes.

Epilepsy surgery is a complex decision involving a thorough evaluation of the patient’s condition, potential risks, and benefits. It is typically considered when other treatments have failed, and the benefits of seizure reduction outweigh the risks. The success of surgery varies among individuals and should be discussed with a multidisciplinary team.