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Treatment of Epilepsy - What are the surgical treatments for Epilepsy?

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What are the surgical treatments for Epilepsy?
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What are the surgical treatments for Epilepsy?
Standard surgical procedures
If drug therapy fails to control seizures, particularly partial, over a two or three year period, surgery may be appropriate. Children and young adults are the preferred candidates, because older people have more difficulty with rehabilitation. Tests for Surgical Decision Making. Advances in imaging and monitoring, new surgical techniques, and a better understanding of the brain and epilepsy in infants as well as in older individuals have made surgery a more viable option than in previous decades. The general approach is first to locate the brain tissue that triggers the epileptic event using long term EEG monitoring, usually with added information from imaging techniques, such as MRI or PET scans.

If such tests detect a specific area in the brain as the location for the seizure, then surgery is possible. The physician then tries to determine if the offending nerve cells perform vital functions usually with the use of advanced MRI techniques. The surgeon’s goal is to remove just enough damaged tissue and no more in order to prevent seizures and limit brain injury. If the diagnostic tests indicate that more than one site is involved or they have conflicting results, then more invasive monitoring of the brain is required.

Surgical procedures may be considered to prevent seizures.
These procedures include:
Disconnection procedures – These procedured disrupt abnormal electrical activity that occurs in the brain and triggers epileptic seizures. Two types of disconnection operations are:
Corpus callostomy – Used to stop atonic and tonic seizures.
Multiple subpial transections – Used when seizures are caused by parts of the brain that can’t be removed.
Focal resections – Focal resections are the most common surgical approach for treating epilepsy and provide the best chance for patients to gain complete seizure control. These procedures involve the removal of a small area of the brain where seizures originate. New brain monitoring techniques allow doctors to better pinpoint brain tissue causing seizures.

Types of resections include
  • Temporal lobectomy – A portion of the temporal lobe is removed to control seizures.
  • Lobar resection – A portion of a seizure, producing lobe, frontal, parietal or occipital lobe – is removed, if it can be done without damaging vital functions.
  • Hemispherectomy – One sphere of the brain is removed or disabled. The remaining half of the brain takes over many of the functions of the half that was removed. This procedure is used to treat severe conditions that have not responded to other treatments.
  • Gamma Knife radiosurgery – The Gamma Knife delivers a finely focused, high dose of radiation to remove tissue without damaging surrounding tissue. Some types of seizures, such as gelastic seizures which are accompanied by brief, sudden bursts of emotion, can be treated with this technology.
  • Vagus nerve stimulation – This procedure involves minor surgery and is a relatively new treatment that helps prevent or lessen the severity of seizures. An electrical stimulator is implanted that sends regular electrical pulses through the vagus nerve to the brain to reduce the onset or frequency of seizes.
If a seizure occurs between doses of current, you or your child can pass a magnet over the device to trigger an additional dose. A child with a vagus nerve stimulator continues to take medication but sometimes can reduce the amount or number of medications. This procedure can treat a wide variety of seizure disorders when surgery isn’t an option.

Prevention and Follow–Up
To help cope with epilepsy and reduce your chance of injury from seizures, doctors recommend the following
  • Patient should carry identification, that indicates he or she has epilepsy. In an emergency, this information can ensure that you receive the right care.
  • Explain to your family, friends, teachers, relatives and sports coaches how to care for you if he or she has a seizure.
  • If you get regular or even occasional seizures, make sure he or she avoids dangerous situations and activities. Eg. Be careful when playing sports and should not swim unattended.
  • Should never stop taking seizure medication or change the amount taken without discussing it with a doctor first.
  • Always consult your doctor or pharmacist before taking other medications in addition to seizure drugs.


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