When antiepileptic drugs fail to control seizures and convulsions, an epilepsy surgery may be recommended. Dr. Rajan Shah, Neurologist, Nanavati Super Speciality Hospital assures that with advances in technology and dedicated centres, epilepsy surgeries have become safer and can be considered a treatment option.
What are the common causes of epilepsy?
Common causes of epilepsy in children and adults are different. They are briefly enumerated as –
Head trauma – SDH, EDH, contusions.
Ischemia - Stroke is a leading cause of epilepsy in adults older than age 35.
Infectious diseases - Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
Prenatal injury - Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.
Developmental disorders - Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.
Genetic influence - Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it's likely that there's a genetic influence.
SAH – aneurysmal and non-aneurysmal bleed, Intra ventricular haemorrhage.
Tumours – Glioma , meningioma and etc.
What are the conventional methods of treating epilepsy?
Conventional method of treatment for epilepsy is antiepileptic drugs.
What should people do if medications do not stop their seizures?
If medications do not stop epilepsy, then patient should consult an epileptologist or neurologist master in treating epilepsy. Such patients need thorough investigation to find out the cause of refraction.
When is surgery considered an option for treatment of epilepsy?
The AAN (American Association of the Neurology) Guidelines –
- Patients with disabling complex partial seizures, with or without secondarily generalized seizures, who have failed appropriate trials of first line antiepileptic drugs, should be considered for referral to an epilepsy surgery centre for Surgery (Level A)
- Patients referred to an epilepsy surgery centre for the reasons stated above who meet established criteria for an anteromedial temporal lobe resection, and who accept the risks and benefits of this procedure, as opposed to continuing pharmacotherapy, should be offered surgical treatment (Level A).
- There is insufficient evidence at this time to make a definitive recommendation as to whether patients with a localized neocortical epileptogenic region will benefit or not benefit from surgical resection (Level C).
- Known anatomical tumours, cerebral infarct or bleed.
What types of epilepsy surgery are there?
Classification of epilepsy surgeries are –
- Resective surgery – Anterior lobe resections, amygdala hippocampectomy resections, temporal lobectomy.
- Multiple subapical transection
- Hemispherectomy that can be anatomical hemispherectomy and functional hemispherectomy
- Corpus callosotomy
- Vagal Nerve stimulation
- Deep brain stimulation.
What are the chances of becoming seizure –free after surgery?
The success rate depends on the type of surgery. Approximately 7 out of every 10 children who have had surgery will stop having seizures after their surgery. In adults, 8% is the success rate for medical refractory surgery. Engel classification is used to calculate success of epilepsy surgeries. To note is that accurate diagnosis is important at an early age to increase the effectiveness of surgery.
A surgery of the brain sounds quite frightening. How safe is epilepsy surgery?
With advances in technology and dedicated centres, epilepsy surgeries are quite safer. For any type of surgery, there are possible risks relating to how the person responds to anaesthetic, or to any complications that happen during the operation. Risks for epilepsy surgery will vary depending on what type of surgery a person has. The most common type of epilepsy surgery is removal of part, of the temporal lobe. Possible risks of this type of surgery include problems with memory, a partial loss of sight, depression or other mood problems. These risks will vary from person to person, and may be only temporary in some cases.
Does a brain surgery impair memory?
The temporal lobes handle memory and language, so any surgery on the temporal lobes can cause problems with remembering, understanding and speaking. The memory problems can be for things that a child has seen (‘visual memory’) or for things that a child has heard (‘auditory or verbal memory’).
What is vagus nerve stimulation (VNS) therapy for epilepsy?
Vagus nerve stimulation prevents seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. It is sometimes referred to as a "pacemaker for the brain." A stimulator device is implanted under the skin in the chest. An electrode from the device is wound around the vagus nerve in the neck.
How can a person prevent epilepsy?
- Since the cause of epilepsy is often unknown, it can't be prevented, but the seizures associated with epilepsy can be.
- Knowing your triggers can help prevent seizures
- Get plenty of sleep each night — set a regular sleep schedule, and stick to it.
- Learn stress management and relaxation techniques.
- Avoid drugs and alcohol.
- Take all of your medications as prescribed by your doctor.
Read here: How to stop epileptic seizures
Is there a link between autism and epilepsy?
Yes, there is an association between epilepsy and autism. Children with autism are (a little) more likely to have epilepsy. Children with epilepsy are (a little) more likely to have autism. Seizures are the most common neurologic complication in Autism.
What are the future trends for epilepsy treatment?
Laser interstitial thermal therapy -This is a type of laser ablation, a minimally invasive, targeted procedure in which we burn away targeted tissue in the affected area of the brain.
Closed-loop neurostimulation - Though this breakthrough procedure is still in the trial phase.
