Epilepsy Services: Surgery
UW Health's comprehensive epilepsy program at UW Hospital and Clinics in Madison, Wisconsin, offers state-of-the-art care for patients with epilepsy or those suspected of having seizures.
Evaluating Epilepsy Patients for Surgery
- If their seizures have been treated with two or more drugs in separate trials and in various combinations
- If their seizures are uncontrolled for two years
Epilepsy surgery candidates must have a record of the antiepileptic drugs that have been tried, including dosages, blood drug levels and adverse effects. When seizures are associated with abnormalities such as blood vessel malformation or brain tumors, proving that drug therapies are ineffective is less important.
Patients with intractable seizures undergo diagnostic tests to explore whether surgery will have a negative impact on the patient's language, memory, movement and sensation. Surgical candidates must evaluate the risks and benefits of surgery, and should they decide to proceed with surgery, will undergo one or more of the following diagnostic tests, which determine specific characteristics and locations of the seizure:
Surgical Treatments for Epilepsy
- Anterior Temporal Lobectomy: The most common epilepsy surgery, this surgery involves partial or full removal of the temporal lobe, which controls memory, emotion and language comprehension. Thorough pre-operative testing can help ensure surgery does not disrupt those important functions. Success rates: Results vary but many U.S. studies show 60-70 percent of patients are free of seizures in the short term and 50-60 percent 10 years after the surgery.
- Extra-temporal surgery: Consists of resection of the frontal lobes, parietal lobes or occipital lobes and represents about 25 percent of all epilepsy surgeries. Success rates: 40-50 percent success rates, and rates improve for patients with an identifiable malformation.
- Hemispherectomy: Involves disconnecting one cerebral hemisphere from the rest of the brain and only considered in patients with severe epilepsy, usually children, whose seizures are traced to one side of the brain.
- Lesionectomy: Refers to the surgical removal of lesions identified by MRI as the cause of seizures.
- Multiple subpial transection: Involves a series of shallow cuts into the cerebral cortex to control seizures without damaging areas of the brain that control important functions such as language comprehension and motor skills.
Risks Involved in Epilepsy Surgery
When evaluating surgical risk it is important to bear in mind that surgical risks pose no greater risk for permanent disability than the cumulative effect of recurrent seizures.
- Bleeding or stroke: Occur in approximately 1 percent of patients undergoing one-stage procedures and 2 percent of patients undergoing two-stage procedures. The risk may be higher for patients who have already underwent brain surgery, older patients and patients with histories of complication.
- Death: Rare but can result from surgical complications like pulmonary embolism.
- Surgery usually takes three to four hours
- Patients are often discharged from the hospital in three to four days after surgery and return to work or school in four to six weeks
- The most common problem after surgery is wound infection and is marked by swelling, pain and fluid drain
- For two-stage procedures, patients stay in the hospital for 14 days, which includes seven day of invasive EEG monitoring