An overview of Epilepsy Surgery
An epilepsy surgery test is a series of evaluations and procedures performed to identify the source of seizures and understand the functioning of specific areas of the brain. These tests aim to determine the appropriate surgical site and help preserve brain function during the operation. Some of the standard tests used for epilepsy surgery evaluation include baseline electroencephalogram (EEG), video EEG, positron emission tomography (PET), single-photon emission computerized tomography (SPECT), magnetic resonance imaging (MRI), magnetoencephalography (MEG), invasive EEG monitoring, and neuropsychological tests. These tests provide information about the brain's electrical activity, blood flow, and functional areas, which assists the healthcare team in planning and executing the surgery effectively.
What is Epilepsy Surgery used for?
Epilepsy surgery is used for treating medically refractory epilepsy or drug-resistant epilepsy, a condition where anti-seizure medications have failed to control seizures. The primary goal of epilepsy surgery is to stop seizures or limit their severity, as well as to decrease seizure-related deaths, the use of anti-seizure medications, and possible side effects of these medications. The surgery aims to remove the area of the brain where seizures occur, with resective surgery being the most common approach, involving the removal of a small portion of the brain. Other epilepsy surgery options include laser interstitial thermal therapy (LITT) and deep brain stimulation, which are less invasive procedures guided by MRI.
How to prepare for Epilepsy Surgery?
Before an epilepsy surgery test, patients may need to prepare in the following ways:
- Follow any dietary restrictions or instructions provided by the healthcare team, including fasting for a certain period before the test.
- Inform the healthcare team about any medications, supplements, or herbal products the patient is taking, as some may need to be adjusted or temporarily discontinued before the test.
- Arrange for a ride to and from the testing facility, as the patient may not be allowed to drive immediately after the procedure.
- Bring any necessary medical records, test results, or referrals to the appointment.
- Follow any additional guidelines provided by the healthcare team, such as avoiding physical activity before the test or wearing loose, comfortable clothing on the day of the procedure. It is important for patients to follow the healthcare team's instructions carefully to ensure the test is accurate and safe.
How is Epilepsy Surgery conducted?
An epilepsy surgery test typically involves a series of evaluations and procedures to identify the source of seizures and understand brain function. The tests may include a baseline electroencephalogram (EEG), video EEG with invasive electrodes, positron emission tomography (PET), single-photon emission computerized tomography (SPECT), and neuropsychological tests.
How are Epilepsy Surgery results reported?
The results of epilepsy surgery are reported based on seizure control, the type of surgery performed, and the duration of seizure-free outcomes. The expected outcome is seizure control with medication. The most common and best-understood procedure, resection of tissue in the temporal lobe, results in seizure-free outcomes for about two-thirds of people. If a person does not have a seizure in the first year after temporal lobe surgery, the likelihood of being seizure-free at two years is high. If there are no seizures in two years, the likelihood of being seizure-free is even greater at five and 10 years. The health care provider may consider decreasing and eventually discontinuing anti-seizure medicine if there are no seizures for at least one year.
Understanding the report
Epilepsy surgery results are interpreted based on the success in controlling seizures and the patient's quality of life after the procedure. The most common and best-understood procedure, resection of tissue in the temporal lobe, results in seizure-free outcomes for about two-thirds of people. Studies show that if a person does not have a seizure in the first year after temporal lobe surgery and takes seizure medicine, the likelihood of being seizure-free at two years is 87% to 90%. If there are no seizures in two years, the likelihood of being seizure-free is 95% at five years and 82% at 10 years. Interpreting the results also involves assessing the patient's overall well-being, including any changes in cognitive function, mood, and quality of life. Neuropsychological tests are usually recommended before the procedure to measure verbal and nonverbal learning skills and memory function, which can provide a baseline for evaluating post-surgery outcomes. In cases where seizures recur after surgery, healthcare providers may consider adjusting medication or exploring additional surgical options.