Epilepsy is a condition where a person has recurrent seizures, or abnormal surges in brain electrical activity, from an irreversible cause. It is the fourth most common disorder in neurology. About 1 in every 26 people will have epilepsy at some point in their lives.
What Causes Epilepsy?
The cause of epilepsy is unknown in many people. Sometimes it is from a problem with one’s genes. Others have epilepsy caused by an abnormality of how the brain is organized. This could be due to a birth defect, stroke, tumor or scar tissue.
What Happens When Medicines Don’t Work?
About 7 in 10 people with epilepsy will not have any seizures after trying 2 medicines. For the other 3 out of 10 people, medicines are unlikely to eliminate seizures. This is called drug-resistant, or medically intractable, epilepsy.
How Do We Treat Drug-Resistant Epilepsy?
The best treatment for drug-resistant epilepsy is often surgery. Epilepsy surgery has been used for over 100 years, but has changed a lot in that time. When a child has drug-resistant epilepsy, an epilepsy doctor or practitioner will typically recommend tests to check for the next best treatment choices.
How Can We Determine if a Patient is Eligible for Surgery?
Not every patient who has drug-resistant epilepsy will benefit from surgery. Testing for this will commonly include a long (around 5 days) EEG in the hospital to record seizures. They will also need a brain MRI, other brain pictures, and developmental testing. This information is then reviewed by a group of experts, who give a treatment recommendation to families.
What Types of Surgeries Are Available?
There are two main types of surgery for epilepsy. Some surgeries can cure epilepsy. Other surgeries can make seizures less common, or shorter or less dangerous.
Curative surgery typically involves taking out, disconnecting or using a laser to vaporize the part of the brain causing seizures. Sometimes that area can be easily seen with the first set of tests and only one surgery is needed. Other times, this part is harder to find. Then, EEG electrodes may be placed into or onto the brain itself, allowing doctors to see the seizures more clearly. After the part of the brain causing seizures has been found, doctors may recommend a specific kind of treatment.
When the part of the brain causing seizures cannot be removed safely, some people may still benefit greatly from surgery. An example of this is a corpus callosotomy, a surgery that decreases the length and severity of seizures by disconnecting the major connection between the two sides of the brain. Some medical devices, called neurostimulators, may also reduce seizures. Some examples of these include vagal nerve stimulation (VNS), responsive neurostimulation (RNS) or deep brain stimulation (DBS).
What Are the Complications of Epilepsy Surgery?
Sometimes, the seizures come from areas of the brain that have important jobs. The team of doctors will perform tests to find these areas and work to keep these safe during surgery. The good news is that in young children, many of these jobs can be learned by other brain areas. This is called neuroplasticity.
Brain surgeries can have side effects, but are much safer than in the past. These can include infections, bleeding or strokes. Overall, surgeries for epilepsy are safer than having continued seizures for most people.
What Is the Recovery Time from the Surgery?
This depends on the type of surgery and if there are complications. Some patients go home one or two days after the surgery. Others may stay in the stay in the hospital for several weeks to receive rehabilitation therapies.
For more information on epilepsy services at Nationwide Children’s hospital, click here or listen to our PediaCast.
Adam Ostendorf, MD, is an attending pediatric neurologist at Nationwide Children's Hospital and assistant professor of Clinical Pediatrics and Neurology at The Ohio State University College of Medicine.
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