What is the best surgery for epilepsy? Let's talk about epilepsy surgery.

Do you often have seizures? Or does someone you know have epilepsy, or as some call it, convulsions? Even with medication, it can sometimes be very difficult to control this condition. So, in cases where it is difficult to control with medication alone, a special treatment method that doctors recommend is epilepsy surgery. Although this is a bit of a serious word, let's talk about it simply.

What is Epilepsy Surgery?

Simply put, epilepsy is an abnormal, uncontrolled electrical activity that occurs between nerve cells in our brain. This is what causes a fit. It can cause temporary changes in your consciousness, behavior, emotions, and body control.

Epilepsy surgery is an operation on the brain to completely stop these seizures or reduce their frequency and severity .

Your doctor will explain to you whether this is right for you and what the results will be.

In what cases is this type of operation necessary?

Surgery is not the first line of treatment for epilepsy. However, a doctor may consider surgery in the following situations:

• If the fit cannot be controlled with anti-seizure medications.
• If the fit is caused by another medical condition, such as a brain tumor .
• If the side effects of the medication outweigh the benefits.
• Special dietary regimens, such as the ketogenic diet, if other treatments are not successful.
• If the fit is so frequent and severe that it interferes with your life to the point where you can't even do your daily tasks.

But remember, if the location of the seizure is found in a part of our brain that controls very important things like memory, movement, and speech, surgeons will not operate on that area. Instead, they will look for other treatment options.

What are the main types of these surgeries?

There are several types of surgery depending on where in the brain the seizure is starting and what is causing it. These are a bit complicated, but let's keep it simple.

What tests are performed before the operation?

Because this is a major operation, many tests are performed before it. The main objectives of these tests are:

• The fit begins with finding out exactly where in the brain it is.
• Make sure that the part to be removed during the operation can be safely removed .
• Identify the areas that control important functions such as speech, memory, and movement that are close to where the fit occurs.
• Predict the possible results after the operation.

These tests can be divided into two main stages.

Phase I (tests without surgery)

• EEG (Electroencephalogram): This measures the electrical activity of the brain. You may be admitted to the hospital and an EEG may be taken with video right at the time of the seizure.
• PET (Positron Emission Tomography) Scan: This scan can help locate the problem, even when there is no fit.
• Neuropsychological Evaluation: This measures things like your speech, memory, and learning abilities. This is important to see if there is a difference before and after the operation.
• Functional MRI (fMRI): This scans the brain's activity during tasks such as remembering something or reading, and identifies areas that control important functions.

Phase II (tests performed after an operation)

If the Phase I tests are not enough information, these tests are done to look more deeply into where the seizure is coming from. In this, a small operation is performed and electrodes are placed on the surface or inside the brain to collect information.

• Stereoelectroencephalography (SEEG): Electrodes are placed at different depths in the brain and the onset and spread of the seizure are observed in 3D.
• Subdural Grid Implantation: Electrode plates are placed on the surface of the brain to monitor the onset of seizures and the location of important activity.

You may not need to have all of these tests. Your medical team will decide which tests are appropriate for you, based on your condition.

What happens during the operation?

First, they will cut some hair at the site of the operation. Don't worry about that , your hair will grow back beautifully when you recover. Then you will be given general anesthesia, so you won't feel anything, you will be asleep.

The surgeon may remove a small part of the skull and perform an EEG during the operation to confirm exactly where the seizure is occurring.

Then you are put to sleep again, and the necessary treatment is given to the affected brain tissue. Finally, the removed piece of skull is put back in place, secured with small titanium clips, and the skin is sewn up.

What to expect after the operation?

After the operation, you will be taken to an observation unit. You may need to stay in the intensive care unit (ICU) for about a day, and then in the hospital for about three to five days.

You can expect things like swelling of the head and face, headaches, etc. They are given medication for these. These will subside in a few weeks. However, if the pain is severe or if you experience other unusual symptoms , you should tell your doctor immediately.

It usually takes about 4-6 weeks to get used to daily activities and 1-3 months to return to work or school. However, it can take about two years to see the full results of the operation.

What are the benefits and risks of this?

Like any operation, this one has both benefits and risks.

The medical team is doing its best to minimize these risks.

When do you want to see the doctor again?

After you go home, if you experience severe pain, swelling, bleeding , or symptoms such as fever at the site of the operation, notify your doctor immediately. Also, be sure to attend the clinics on the days your doctor prescribes to monitor your recovery.

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