Epilepsy surgery can help in controlling seizures, says expert
Medications can control seizures in most people with epilepsy, but they do not work for everyone. About 30 per cent of people taking the drugs cannot tolerate the side effects. In selected cases, brain surgery may be an option.
An operation on the brain can control seizures and improve the quality of life for patients. The surgery has three main goals: > Surgical removal of the brain area where the seizure is originating > Surgical disruption of the nerve pathways that seizure impulses take through your brain to spread from its origination to becoming generalized resulting in unconsciousness > Implant a device similar to a pacemaker device in the heart to modulate electrical activity in the brain to prevent seizure from developing. Not all patients are candidates for epilepsy and not all types of epileptic fits are amenable to surgical procedures. Repeated counselling of patient and family members regarding expectations from epilepsy surgery must be clarified and documented before the decision to operate is finalised. Epilepsy surgery is an option only if: > Your doctor can clearly identify the area of the brain where the seizures originate, called the ‘seizure focus’. > The area to be removed doesn’t control a critical function like language, or movement.
Evaluation for being a candidate for surgery is commenced when the patient is suffering from Drug Refractory Epilepsy. The investigative armamentarium includes:
> MRI brain — Epilepsy protocol based MRI brain which determines the structural abnormality. It can be visualised as a tumour, atrophy overgrowth or dysplasia etc.
>Video EEG — This is an extended form of routine EEG done for all epilepsy patients. The patient is admitted to the hospital and hooked to an EEG machine for the entire duration of admission. All activities are recorded both on camera and EEG. > Electrocorticography — At times, routine EEG is not enough especially if the focus is deep seated. In that case we may need to do an Electrocortigraphy in which electrodes are directly put on brain surface following a craniotomy in ICU setting.
> PET FDG— It is another modality of nuclear medicine besides Ictal and Interictal SPECT which can be used to determine the epileptic focus. > Functional MRI Brain — It is one of the latest and very useful modality of imaging added in recent times. In this procedure, the patient performs certain tasks while he is being imaged. The corresponding part of the brain gets activated in the process.
Once it is determined that a patient has Drug Resistant Epilepsy, the epilepsy team will do a detailed analysis of the EEG, video EEG, CT and MRI images, detailed psychological assessment to decide which procedure is best suited to alleviate the seizures.
The main purpose of all the investigations is that before opening the brain for surgery, the doctors can be sure of the exact location and what part they are going to dissect in order to achieve best results with minimum deficit.
Benefits of surgery vary from helping reduce falls during a seizure, decreased number of epileptic attacks, halt progressive neurological deficit and in a few cases may make patient seizure and drug-free for life. Some people are completely free of seizures after surgery. Others still have seizures, but less often.
The risks in surgery consist of craniotomy which is the opening of the skull to reach the area where the epilepsy is originating or spreading from; and the surgical procedures. Dr Hillol Kanti Pal is a consultant neurosurgeon at the International Modern Hospital. (This article has been sponsored by the advertiser)