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What Are the Surgical Options for Treating Epilepsy?

Learn about surgical options for treating epilepsy from Steve Wolf, MD and Patty McGoldrick, NP in this Howcast video.


- Patty McGoldrick:Let's talk about the different kinds of epilepsy surgery that are available to patients with intractable epilepsy. The first one, and the one that people most commonly think of as epilepsy surgery, is resective surgery, where we go in and pinpoint what area of the brain the seizures are coming from and take out that area.

But, there are several other types of surgery that can be done, one of which is a corpus callosotomy. This works very, very well for people who have drop seizures, or atonic seizures. So, in the surgery, the surgeon enters through here and severs that connection so that the seizures do not spread from one side of the brain to the other - from the right to the left or from the left to the right. Another type is the vagal nerve stimulator.

- Steve Wolf:This is a pacemaker that is implanted underneath the skin and the wire is gone underneath the skin to the nerves in the neck called the vagus nerve. And this little device shoots little electrical impulses into the brain to help decrease the amount of seizures.

And if the patient feels a seizure coming on, they can swipe it with a special magnet and can send an extra impulse to the brain to help break the seizure and stop the seizure from happening. So these are what we call a palliative type of seizure surgery types. This one does not require you going to the brain. The corpus callosotomy, you're not taking anything out. All you're doing is separating the brain from the left from the right to help decrease the amount of seizures that are happening.

- Patty:And to decrease the spread of the seizures. So, this is good for seizures that start in one area and propagate to the other side of the brain.

- Steve:Every once in a while when we're doing epilepsy monitoring, trying to find out where the seizures come from, they can come from these areas that are different in colors on the brain and this is the motor strip, where your arm or leg is, and then this is the sensory strip. And if seizures come from right there and we do surgery to take that out, you're going to make the patient totally weak and paralyzed.

So, sometimes, if we find seizures coming from there, we'll do a special type of surgery called MST or multiple subpial transections. And instead of taking out the brain, they'll actually do small cuts, micro cuts, inside that area to help decrease the risk of seizures. And that will allow the patient not to be paralyzed, but hopefully get some seizure control. So, these seizure options are palliative. They help decrease the seizures, might or might not stop all the seizures.

- Patty:So, you look at them as another medication that will help decrease the seizure a little, but may not necessarily cure the epilepsy. So, in terms of epilepsy surgery options, these are for people with intractable epilepsy.

The different options include resective surgery, where we take out a little portion of the brain where the seizures are coming from. There's also corpus callosotomy, where we sever the connections between the two sides of the brain, which is really used for atonic seizures or those very disabling drop attacks. We can do a vagal nerve stimulator, which involves putting a pacemaker in the chest wall and threading the wires up to the brain to decrease the frequency of the seizures.

The advantage of this is that you can also have a magnet so you can abort seizures and prevent seizures. And then the last is multiple subpial transections, and this is in people who would be candidates for resective surgery but where the area of the brain that's involved in propagating the seizures is an eloquent area that controls motor or speech or sensory, so that you sort of rake the area and sever the connections to stop the seizures without losing function.

So, for people with intractable epilepsy, these are really good options to discuss with your neurologist, epileptologist and your neurosurgeon before you get too far down the road. They shouldn't be left as the last resort; they should be discussed much sooner.

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