Do you have epilepsy ? You may have been taking medication for a long time. But there are times when your seizures cannot be completely controlled even with medication. In such cases, your doctor may have told you about surgery. When you hear the word " brain surgery," your body tingles, right? It's normal to feel scared. But this can be something that can change your life for the better. So, putting the fear aside, let's get to the bottom of it, shall we?
What exactly is epilepsy surgery?
Simply put, this is a brain surgery that can stop your seizures , reduce their frequency, or reduce their severity. Do you know how a seizure occurs? A seizure is a sudden, abnormal electrical activity between nerve cells in your brain. This can affect your consciousness, behavior, emotions, and muscle control.
The most important thing is that this surgery is not a complete cure for epilepsy. There is no 100% guarantee that you will never have seizures again after surgery. However, it has the potential to significantly improve your quality of life . Not everyone's results are the same, and they vary from person to person.
Your doctor will explain to you in detail whether this surgery is suitable for you and what you can expect from it.
When is surgery needed?
Surgery is not the first choice when treating epilepsy. A doctor may consider it in the following situations:
- The cause of the seizure is not epilepsy itself, but another condition, such as a brain tumor or an abnormal blood vessel condition (arteriovenous malformation).
- If seizures cannot be controlled despite using one or more antiepileptic medications.
- Side effects caused by medication, if the benefits outweigh the benefits of the medicine.
- If other treatments, such as a ketogenic diet, are not successful.
- If your seizures are so frequent that they interfere with your life that you cannot even perform daily tasks properly.
But remember, if the part of the brain where the seizure is occurring is one that controls very important functions like memory, movement, and thinking, the surgeon may decide not to operate on that part. Then they will consider other treatment options.
Are there any types of these surgeries?
Yes, there are several types of epilepsy surgery . The type of surgery performed depends on factors such as where the seizures start and what is causing them. Let's take a brief look at some of the main types.
| Type of surgery | Simply put, what happens? |
|---|---|
| Surgical Resection | This involves surgically removing the part of the brain where the seizures begin or the abnormal tissue that causes them. |
| Surgical Disconnection | By cutting off the nerve connections between parts of the brain, seizures stop spreading throughout the brain. |
| Laser Interstitial Thermal Therapy | Using an MRI scan, a tiny laser beam is sent into the brain to destroy the cells that cause seizures. This is a less invasive method than open surgery. |
| Implantation of a device (Neuromodulation) | A small device and electrodes are placed in the brain or a nerve that can send electrical signals to the point where the seizure starts and stop it. Vagus nerve stimulation is one such device. |
| Implantation of electrodes | Sometimes, it is necessary to record signals directly from the brain. In this case, electrodes are placed on or inside the brain and the data is collected. From this data, the surgeon determines the best treatment method. |
How do you prepare before surgery?
Before your surgery is scheduled, you will meet with your neurosurgeon. He or she will explain everything about the surgery, including the steps, benefits, and risks. This is a good time to ask any questions you may have. Once you understand everything, you will be asked to sign a consent form.
In addition, the surgeon may give you advice like this:
- Explains what tests need to be done before surgery.
- You may be asked to make changes to the medications you are currently taking (perhaps stopping a medication or starting a new one).
- If someone smokes, they are told to stop or cut down.
- They will tell you to talk to your family and make a plan so they can support you after the surgery.
What tests are done before surgery?
Many tests are performed before surgery. The main objectives of this are:
- Find out exactly where in the brain the seizure starts.
- Determine if that part can be safely removed.
- Look for areas that control important functions such as speech, memory, and movement close to the point of seizure onset.
- Predict the outcome after surgery.
These tests are usually divided into two stages. The first stage involves non-surgical tests. The second stage involves a minor surgery to obtain the information.
| Testing phase | Types of tests performed |
|---|---|
| Stage I (without surgery) |
|
| Stage II (with surgery) |
|
What actually happens during surgery?
First, a small amount of hair will be cut off at the surgical site. Don't worry, your hair will grow back as you heal. Then, an anesthesiologist will put you under general anesthesia. This means you will be asleep for the duration of the surgery. The medical team will continue to monitor your heart rate and blood pressure.
The surgeon will remove a small piece of your skull and place it on the side. An EEG may be performed during the surgery to determine exactly where the seizures are coming from.
Surprisingly, sometimes the surgical team can wake you up during surgery. They ask you questions and map out the exact areas of your brain that control important things like speech, hearing, and movement. You won't feel any pain during that time.
Once that is done, you will be put back under anesthesia. Then the surgeon will perform the necessary treatment on the part of the brain that is causing the seizures. Finally, the removed piece of skull will be replaced and secured with small titanium clips. Then the scalp will be carefully sewn up and covered with a bandage.
What happens after surgery? How long will it take to recover?
After surgery, you will be taken to an observation unit. You may need to stay in the intensive care unit for a day. Usually, you will stay in the hospital for three to five days.
In the early days, you can expect things like swelling of the head and face, and headaches. The doctor will prescribe medication for these. These will go away in a few weeks. However, if the pain is severe or if you have other unusual symptoms, inform the doctor immediately .
You need to rest well. It usually takes four to six weeks before you can gradually return to your daily activities. It takes about one to three months to return to work or school. However, it can take about two years to see the full results of the surgery.
The most important thing is that you will need to take your epilepsy medication for a while after surgery. This is to protect your brain while it heals and to prevent future seizures. If you don't have any seizures after about a year, your doctor may decide to gradually reduce your medication and eventually stop it.
What are the benefits and risks of this?
Like any surgery, it has benefits and risks. It is important to be aware of both.
| Benefits | Risks |
|---|---|
|
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Don't be afraid of these risks. The medical team tries to minimize these risks as much as possible through pre-surgery tests.
Take-Home Message
- Epilepsy surgery is an important treatment option considered when seizures cannot be controlled with medication.
- This is a big decision, so be open and honest with your doctor and ask any questions you have.
- Before surgery, many tests are performed to protect you and get the best results.
- Although there is no guarantee that this will cure epilepsy 100%, it has a high potential to change your life for the better.
- It takes time to heal. It is very important to be patient and follow the doctor's instructions.
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