Epileptic seizures could be as a consequence of temporal lobe epilepsy (about 80%) or due to various brain conditions such as gliosis, low grade tumors and vascular malformations in brain.Overall 70 % of the patients respond to medications but for rest 30% patient’s surgery is the solution.
Epilepsy surgery is a surgical procedure performed in the brain to control seizures due to above mentioned conditions and improve the overall quality of life. It is usually considered when medications fail to control seizures.
Temporal lobe epilepsy (partial/localized) is the commonest form of epilepsy for whichlobe resection procedure is done. The brain tissues in the lobe area are cut away to remove the seizure focus. Detailed brain mapping is performed prior to the surgery by our neurologist to ensure that only abnormal tissue is removed. In OT sophisticated technologies such as stereotactic implantation of electrodes is done to remove as little as tissue possible, as safely as possible, to eliminate seizures.
Toremove the brain tissue from areas outside of temporal lobe, you would need extratemporal resection. In Corpus callosotomy, doctor cuts the corpos callosum, which connects two halves of the brain. For children smaller than 13 years, the most preferred procedure is in the form of functional hemispherectomy. In this procedure, hemisphere is left in place but is disconnected from the rest of the brain.
Prior to getting admitted in hospital you would undergo several investigations on OPD basis. You would require prolonged EEG video monitoring. This help to distinguish between partial (or focal epilepsy, where seizures are localized at onset, and general epilepsies, where seizures arise from whole brain.
You would also undergo neuropsychological testing and epilepsy specific MRI’s.
Your surgery shall be planned. You and/ or your relative is explained the procedure in detail and consent is undertaken. Pre-anaesthesia checkup (PAC) is done. Intravenous line (IV) is given to provide fluids. You are shifted to OT for procedure. You are given anaesthesia before surgery. Post procedure, you will be moved to normal room.
You would continue to stay on IV medications. You would be slowly mobilized by rehabilitation team. You will also undergo mild physiotherapy. Your catheter would be removed and you would be encouraged to use regular washroom.
Discharge process is undertaken. You will be explained about the discharge medication and follow up. You will be discharged in stable condition.
Overall about 70% of the patients who undergo epilepsy surgery become seizure free, however, where the results of EEG and MRI are in agreement, the chances of becoming seizure free are as high as 90%.
You may get off medications or have decrease in intake of medications. It’s very rare that surgery doesn’t help at all.
Follow up if necessary to gauge your progress. You will review your recovery and let the doctor know about any seizure activity.