Can epilepsy be cured by surgery?

Am I a candidate for epilepsy surgery?

The goal of epilepsy surgery is to reduce or eliminate seizure activity while avoiding damage to other areas of the brain. At Neurosurgery One, our Denver neurosurgeons offer five different types of epilepsy surgery (resections, ablations/LITT, NeuroPace (RNS), VNS, and DBS) and will discuss the various surgical options with you.

If you are experiencing uncontrolled seizures more frequently than you would like, you may be a candidate for epilepsy surgery. You do not have to wait a certain amount of time before considering epilepsy surgery, and research shows that earlier surgery may be better.

You might be a candidate for epilepsy surgery if you meet these criteria:

• Seizures failed to be controlled with at least two different types of anti-epileptic drugs (AEDs)
• General good health

If you have been diagnosed with a mental illness, such as anxiety or depression, you may have been told you do not qualify for epilepsy surgery. However, often mental illness is a direct result of seizures and does not automatically eliminate you from qualification. At Neurosurgery One, we can help determine if you are a candidate for epilepsy surgery and help you navigate the process.

When should I consider epilepsy surgery?

Studies show that earlier surgery is better to prevent a decline in thinking and functioning caused by uncontrolled seizures. Historically, there has been more than a 20-year delay in referring epilepsy patients for surgery. However, one study found that newly-diagnosed temporal lobe epilepsy patients who underwent surgery combined with medications were much more likely to be seizure free than patients who only took medication. Another study found that for frontal lobe epilepsy, younger age and shorter epilepsy duration at time of surgery resulted in better seizure outcomes.

What types of surgery are used to treat epilepsy?

Neurosurgery One’s fellowship-trained neurosurgeons located in the Denver area specialize in treating patients with epilepsy who could benefit from the following types of epilepsy surgery:

• Resections: The most common type of epilepsy surgery, this procedure removes the small part of the brain causing seizures.
• Thermal/Laser Ablation (LITT): Also known as Laser Interstitial Thermal Therapy (LITT), laser brain surgery for epilepsy uses laser heat to destroy the small area of the brain causing the seizures.
• Responsive Neurostimulation (RNS)/NeuroPace: Similar to a heart pacemaker, this implanted device monitors brain waves for unusual patterns indicating a seizure and automatically sends electrical pulses to interrupt seizure activity.
• Vagus Nerve Stimulation (VNS): A pacemaker-like device is implanted in the chest, and a wire is wrapped around the vagus nerve in the neck. The device sends regular, mild electrical pulses to the brain, preventing seizures.
• Deep Brain Stimulation (DBS): Approved by the FDA in late 2018 for use with patients with epilepsy, this system works similar to the NeuroPace system. Neurosurgery One is a world leader in performing DBS epilepsy surgery using robotic guidance while patients are asleep.

What is deep brain stimulation surgery for epilepsy?

Deep Brain Stimulation (DBS) is a neuromodulation therapy that utilizes electrical stimulation to control areas of the brain causing seizures. Electrodes are placed in the areas of the brain causing seizures, and a neurostimulator is programmed to send pulses through the electrodes to the target area.

Although DBS for epilepsy seizures was only recently approved by the FDA, Neurosurgery One has been a world leader for years in performing DBS using robotic guidance while patients are asleep for other conditions.

DBS is often a preferred surgical option for patients with limbic epilepsy and adults with generalized epilepsy. DBS may be an option for epilepsy patients who cannot benefit from resection surgery, which removes a portion of the brain causing seizures.

What are side effects of brain surgery for epilepsy?

Your potential side effects of epilepsy surgery depend on the type of procedure you have. You may experience headaches and swelling of the head and/or face after epilepsy surgery. Medications will be administered to reduce these side effects.

Brain surgeries for epilepsy carry low risks of side effects, including bleeding, infection, memory issues, and depression. For some procedures like RNS, VNS, and DBS, there are also risks associated with the implanted device, including infection and, rarely, mechanical or electrical issues.

Learn more about the risks and benefits of epilepsy surgery based on the specific procedure: resections, ablations/LITT, NeuroPace (RNS), VNS, and DBS.

What are brain surgery for epilepsy success rates?

Each brain surgery option for epilepsy surgery has its own success rate. In general, epilepsy surgery eliminates disabling seizures in 60 percent of patients who do not respond to anti-epileptic drugs (AEDs), according to research studies.

Resection surgery and deep brain stimulation surgery for epilepsy have been shown to have success rates of 70% or higher in eliminating seizures in patients. Laser brain surgery for epilepsy (LITT), NeuroPace (RNS), and VNS each have up to 60% seizure-free rates.

In addition, Neurosurgery One has low infection rates and revision rates, ranking among the top in the nation for both categories.

What should I ask a neurosurgeon about epilepsy surgery?

Choosing a neurosurgeon for your epilepsy surgery should be an important part of your process. To help you find a neurosurgeon you trust and who can help you accomplish your goals, consider asking the following questions:

• Do you have extensive training or are you fellowship-trained in neurosurgery?
• Do you specialize in the treatment of epilepsy?
• Have you completed this procedure before? If so, how many times?
• What are the most common complications of this procedure?
• What is your infection rate?
• What is your patients’ success rate with seizure freedom with this type of surgery?
• What does recovery from this procedure entail?
• Where do you perform surgery?
• What types of epilepsy surgery do you offer?

It’s also important to assess your comfort level with a neurosurgeon and his/her staff before you move forward with epilepsy surgery. Consider reviewing the following:

• How do you feel when you walk into the office?
• Do you feel comfortable with the neurosurgeon?
• Are the neurosurgeon and his or her team friendly and competent in addressing your concerns and understanding your goals?
• Do you feel like you have the neurosurgeon’s full attention?
• How do you feel about the access you have to the neurosurgeon and/or staff? Can you call, text, email directly or do you need to work through an assistant or nurse?
• Are the staff helpful with paperwork, travel plans, scheduling, etc.?

How do I prepare for epilepsy surgery?

Once you have made the decision to move forward with seizure surgery, you will want to do the following to ensure the best recovery from epilepsy surgery:

• Continue your medications as instructed by your epilepsy team
• Maintain a healthy diet and keep well hydrated
• Get adequate sleep
• Stay active
• Foster your support system
• Discuss your surgery with your primary care physician
• Complete pre-surgery tests and lab work
• Follow any pre-surgery instructions recommended by your epilepsy team. You may need to discontinue certain medications that could impact surgery.

What can I expect before epilepsy surgery?

To determine which type of seizure surgery may be right for you, Neurosurgery One partners with you through the following steps:

1. Our neurosurgeon who is specially trained in treating epilepsy will meet with you to determine your goals, review your seizure history to date, and discuss the process.
2. Teaming up with epileptologists at Littleton Adventist Hospital’s Epilepsy Monitoring Unit, we will conduct non-invasive testing to locate the cause of your seizures. These tests may include EEG, MRI, PET, or SPECT. If these test results are inconclusive or conflicting, we may recommend intracranial EEG monitoring to get a more detailed look at your brain activity.
3. Once the cause and location of your seizures are determined, your neurosurgeon will determine the best surgical options for your specific needs and discuss those with you. He will present you with the benefits and risks of the surgery, the research supporting the surgery option, what you can expect as a result of your surgery, and any alternative approaches.

What can I expect during epilepsy surgery?

While every type of epilepsy surgery includes different surgical procedures, in general, you can expect the following during epilepsy surgery.

• Close monitoring by a team of anesthesiologists, nurses, and surgeons to ensure your oxygen level, heart rate, and blood pressure are within safe ranges. The anesthesiologist also will ensure you remain asleep unless directed by the neurosurgeon to test movement or speech during surgery.
• Depending on the type of surgery you have, your hair may be cut or partially shaved to lessen the occurrence of infection.
• Based on the invasiveness of the procedure, seizure surgery can take several hours and varies based on the type of surgery.
• For resection surgery, a craniotomy is performed, in which a small part of the skull is opened so the surgeon can access and remove the abnormal tissue causing the seizures. The skull is secured back in place after the tissue is removed.
• During some epilepsy surgical procedures, EEG (electroencephalogram) monitoring may be done to pinpoint the exact location of the seizures.

What can I expect after epilepsy surgery?

Once your seizure surgery is complete, you will go into recovery. Based on the type of surgery you have, you will either recover in an intensive care unit or the neurosurgery or epilepsy unit.

You may experience headaches and swelling of the head and/or face after epilepsy surgery. Medications will be administered to reduce these side effects.

Depending on the type of epilepsy surgery, you may spend spend 1-5 days in the hospital recovering after epilepsy surgery. Typically, most patients then go home to recover. During the next 4-6 weeks, you will gradually increase your activity. Depending on the type of epilepsy surgery you have, you may see immediate results or gradual results that can improve over months or years.