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What is epilepsy surgery?
Epilepsy surgery is
a name for the different types of brain surgery (also called neurosurgery)
that some people with epilepsy have. There are different types of surgery:
one kind of surgery involves removing the part of the brain that is causing
the epilepsy, another kind involves separating the part of the brain that
is causing
seizures from the rest of the brain.
We use the word surgery to
specifically mean surgery on the brain to treat
epilepsy.
When would someone have surgery?
For some people surgery can stop or reduce the number of seizures they
have. It might be considered if anti-epileptic drugs (AEDs) have not stopped
or significantly reduced the number of seizures a person has.
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How successful is surgery?
Around 70% of people who have surgery find
that the surgery stops their seizures and they
become seizure-free.
After surgery most people will still take their
AEDs for some time. The person and their
neurologist will talk about when would be the
best time to start to slowly come off the AEDs.
Information on AEDs for adults.
Information on AEDs for children.
Can I have surgery?
Surgery is suitable for adults and children.
Whether you are suitable for surgery is
something that you may like to talk to your GP
or neurologist about.
Surgery might be considered if:
• you have tried several AEDs and none of
them have stopped or signifi cantly reduced
your seizures; and
• the physical cause for your epilepsy is found
in only one area of your brain.
If you meet these criteria and are considered for surgery you will need to have further tests
before the surgery can happen. Back to top How will I know if my epilepsy has a
physical cause?
One of the tests sometimes used to help
diagnose epilepsy is a brain scan. You may
have had either an MRI (magnetic resonance
imaging) scan or a CT (computerised
tomography) scan. Although they use different
technology both scans produce an image of
your brain which is used to see if there is a
physical cause for your epilepsy. Physical
causes can include scarring on the brain,
damage to the brain from a head injury, or
following an infection such as meningitis. If a
physical cause is found, it is called the 'epileptic
focus'. The epileptic focus can be different from
person to person.
The tests before surgery
If you are referred for surgery you will probably
go to a specialist centre. There are many
different tests you might be asked to have
before you can be given the go-ahead for
surgery. The tests could include having an EEG
(an electroencephalogram) and video telemetry
(an EEG whilst also being filmed). More MRI
or CT scans might also be useful to get more
information about the epileptic focus.
Information about EEG tests.
Information about MRI tests.
Memory and psychological tests are also used to see how your memory and
lifestyle might be affected after the surgery. These types of test also
help the doctors to see how you are likely to cope with the stress of
having this type of surgery.
The tests you have will confirm whether:
• the surgeons can reach the epileptic focus during surgery and can
remove it safely without causing new problems;
• the other parts of your brain will not be
affected by the surgery, for example the parts that control your speech,
sight, movement or hearing;
• you have a good chance of having your seizures stopped by the surgery;
and
• you have no other medical conditions that would stop you from having
this kind of surgery.
The results from the tests will help you
and your neurologist decide if surgery is an
option and what the result of the surgery might
be. For some people the results show that
surgery is not an option for them; about 50% of
people who are recommended for surgery are
unable to have surgery.
Based on the results
from the presurgical tests your neurologist will talk with you about the
possible risks and benefi ts of having surgery.
Back to top Deciding about surgery
Having any kind of
surgery on the brain is a big decision to make and you may have lots of
questions or concerns that you need to discuss before you are able to
make your mind up. The doctors will be used to this because it is an important
part of deciding about, and preparing for, surgery .To give you the full
picture when deciding about having surgery your doctor will explain to
you about the potential risks of the kind of surgery you are having. Although
your
doctor can give you information and advice, the final decision is yours.
To give you time to talk about how you are feeling about having surgery
most people
will be offered some kind of pre-surgical counselling.
Can I change my mind? You may feel very excited and at the same time
nervous about the surgery and the positive
effect you’re hoping it will have on your life. This
is absolutely normal and is to be expected. You
might also feel that for whatever reason you’ve
changed your mind about having surgery. This is okay – it is a big decision and you have the
right to say no to the surgery if you don’t want it
to have it.
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After surgery
Immediately after surgery your doctors will
monitor your recovery. For the first few days you
may feel very tired and need to sleep, as it can
take a while for the anaesthetic to completely
wear off.
Some people who have brain surgery will
have seizures within the fi rst week of surgery –
but this doesn’t mean the surgery has not been
successful. Seizures after surgery are thought
to happen because of the direct stress the brain
experiences in surgery, rather than because a
person has a history of epilepsy.
How long you may need to spend in
hospital will depend on the type of surgery you
have had and the observations your doctors
make about your initial recovery. Generally
your doctors might expect you to be back to
your normal activity about six weeks after your
surgery.
Following surgery most people will have
reviews with their doctors about their recovery
and any seizure activity – how often you will
need a review will be something you and your
doctors will decide together.
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How will I know if my surgery has worked?
Before your surgery your medical team will have
talked with you about the aims of your surgery
and how successful they expect the surgery
to be. For some people “successful surgery”
may be completely stopping all seizures, for
others it may be reducing the number or severity
of seizures. Usually two years is given after
surgery to fully measure how successful surgery has been.
UK
Epilepsy Helpline: 01494 601400
Monday - Friday 10am - 4pm
©
The
National Society for Epilepsy
April 2008
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