In the event that you do not respond to medication, don’t feel defeated: brain surgery is a viable option. In fact, recent studies show that surgery shouldn’t necessarily be a last resort option. Jerome Engel, Jr., MD, PhD, along with 13 other leaders in the field of Neurology have taken on the issue of why, despite reported success, surgery for pharmacoresistant seizures is often seen as a last resort. These experts wanted to understand whether surgery, soon after the failure of 2 antiepileptic drug (AED) trials, is more effective in controlling seizures and improving quality of life. Their results showed that among patients with newly intractable disabling MTLE, surgery plus AED treatment resulted in a lower probability of seizures during the second year of follow-up, as compared with continued AED treatment alone.
Similarly, a study conducted by the Medical Advisory Secretariat, the predecessor of Health Quality Ontario, reveals that “epilepsy surgery is effective at reducing seizure frequency,” a conclusion supported by two randomized controlled trials.
There are two major types of surgery, both of which limit the frequency of seizures, and potentially even stop them altogether. The first involves removing the seizure-producing area of the brain, the seizure focus. The other surgery interrupts the nerve pathways that the seizure impulses are spread throughout. In order for either surgery option to be considered, the area of the brain where the seizure impulses originate must be pinpointed and cannot be associated with any critical functions such as movement. Epilepsy surgeries can be extremely effective at reducing seizures, and have a relatively high success rate. The results are so impressive that a majority of patients are rendered continuously long-term seizure free. However, you must also consider that as with any surgery of the brain, the risks are high (Dr. Ahmed-Ramadan Sadek from the Wessex Neurological Centre at the University of Southampton).
Common Surgical Options
- Lobe Resection: brain tissue in the specific, seizure causing lobe is removed in order to minimize the seizures. While the success rate for seizure control in temporal lobectomy varies, “over 85% of patients enjoy a marked improvement in seizure control [post temporal lobe resection],” according to the NYU Comprehensive Epilepsy Center.
- Lesionectomy: isolated, seizure causing lesions are removed, thus removing the source of epilepsy. Everyday Health notes “significant improvement in more than 80 percent of people who have lesionectomies,” many of whom do not experience seizures afterwards.
- Multiple Subpial Transection (MST): a series of shallow brain transections are made in the brain tissue, interrupting the movement of seizure impulses while keeping normal brain function intact. This is done only in brain tissue that cannot be safely removed. 70% of patients who undergo MST (mostly children) report satisfactory improvement, according to Medicine Net.
- VNS (Vagus Nerve Stimulator): a VNS device (something similar to a pacemaker) is inserted under the skin on the chest wall, where a wire connects the vagus nerve to the neck. The device sends electrical impulses to the brain which help prevent seizures. For further information on VNS, check out this interview with Meghan O’Neil, who used the device in 2008.
The recovery period for epilepsy surgeries aren’t long at all! They typically last anywhere from 2 to 8 weeks. If you get one of these surgeries, you would be urged to take your medication in lower doses during this period and, if possible, permanently! In rare cases though, some people experience seizures even after surgery. Also, in case you face post-surgical language or memory problems, your doctor will probably recommend speech or physical therapy.
Stuart Ross McCallum talks about epilepsy, surgery, and speaking out in his poignant memoir Beyond My Control. We were able to talk to Stuart about not only his book, but also his resolution to enlighten people about epilepsy. He believes that with each new person educated, the misunderstandings of the condition that has been shrouded by myths will slowly disperse, thereby making the world a better place for all of us living with the much-stigmatized condition we call epilepsy. Click here to read the prologue to his book about recovery from surgery, or visit his website at beyondmycontrol.net!