Epilepsy is a common neurological disorder affecting nearly one in every 100 people worldwide.  The outlook for both adults and children with this disease is better than ever before.  Scientists are making great strides in understanding the cause of epilepsy resulting in more and more treatment options becoming available to patients.

About three-quarters of all people who have epilepsy can control their seizures with medications.  When medications fail to completely control the seizures, alternative treatments such as the ketogenic diet, the vagal nerve stimulator, and epilepsy surgery should be considered.  In general, at least three medications should be tried over a year's time before other treatments are tried.  The focus of this article will be on epilepsy surgery.  It is estimated that 2,000  to 5,000 patients could benefit from this type of surgery each year.

The modern era of epilepsy surgery began just after World War I when doctors began to realize that removal of scar tissue in the brain could stop seizures from occurring.  Up to 75% of patients with uncontrolled epilepsy can be cured with surgery while up to 90% will improve significantly.

Four types of surgery are available.  Removal of one lobe, usually the temporal lobe is the most common procedure.  Rarely one whole half of the brain is removed.  In other instances, the pathways connecting the two sides of the brain are split  (corpus callosotomy).   The key to choosing [the right] type of surgery involves figuring out exactly where in the brain the seizures are coming from.  This is the role of the architect or designer who tells the surgeon where and how much to cut. The neurologist relies on information from many types of tests including video-EEG monitoring, MRI scan, PET scan, SPECT scan, WADA testing, and Neuro psychological testing to find the seizure starting point in the brain.  The next step is to determine whether that part of the brain can be safely removed.  The evaluation process can take several months thus providing plenty of time for all the patient's or family's questions to be answered.

Patients being considered must be committed to the whole process every step of the way.  Sometimes, the hardest part is after the surgery when patients must adjust to a life without seizures.  In general, patients are kept on their medications for an additional 2 to 4 years after the surgery before being taken off of them slowly, assuming that they have remained seizure free.

The goal for anyone with epilepsy should be to have no seizures.  Epilepsy surgery is a proven way to achieve this goal in carefully selected patients.  Those in the Charlotte region are fortunate enough to have access to comprehensive epilepsy care including epilepsy surgery at both of the major hospitals.  Contact your local Epilepsy Foundation office.

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