Epilepsy Talk

Epilepsy and Brain Surgery — The Basics | May 22, 2013

Since there so many different types of brain surgeries — and questions — I decided to learn about them and share my findings with you.

Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn’t interfere with vital functions like speech, language or hearing.

In these types of surgeries, your doctor removes the area of the brain that’s causing the seizures.

If your seizures originate in a part of your brain that can’t be removed, your doctor may recommend a different sort of surgery in which surgeons make a series of cuts in your brain.

These cuts are designed to prevent seizures from spreading to other parts of the brain.

Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages.

The type of surgery used depends on the type of seizures and the area of the brain where the seizures start. The surgical options include:

Temporal Lobectomy: The most common surgical procedure performed for epilepsy is the removal of a portion of the temporal lobe, or temporal lobectomy.

These brain structures play an important role in the majority of temporal lobe seizures involving the seizure focus, or small area of the brain where seizures originate.

The cerebrum, or largest part of your brain, is divided into four paired sections, called lobes — the frontal, parietal, occipital and temporal.

In a temporal lobe resection, brain tissue in the temporal lobe is resected, or cut away, to remove the seizure focus.

In most cases, a mere 2 inches is removed. All or part of a left or right lobe may be removed surgically.

These areas of the brain are common sites of simple and complex partial seizures, some of which may secondarily generalize.

Seizures in the temporal, parietal, frontal or occipital lobes may be treated surgically if the seizure-producing area can be safely removed without damaging vital functions. 

It is the most successful type of epilepsy surgery and over 85% of patients enjoy a marked improvement in seizure control. Most of them need less medication after surgery.

Approximately 25% of those who are seizure-free can eventually discontinue antiepileptic drugs. However, up to 15% of patients notice no improvement post-surgery.

Lesionectomy: About one quarter of patients with recurrent seizures are now discovered to have small, previously unrecognized lesions, for example; a small tumor or an abnormal blood vessel.

Lesions may be located in any of the lobes of the brain — temporal, parietal, frontal, or occipital — and they can cause frequent seizures.

A lesionectomy can be very effective in cases where the whole lesion and a small surrounding margin of brain can safely be removed.

Since surgical removal of these lesions can result in complete seizure control in many patients, the patient is considered an excellent candidate for epilepsy surgery depending on the location of the lesion and its relationship to the cortex.

Removal of the lesion along with a temporal lobectomy yields excellent results in over 80% of cases, particularly those with refractory seizures.

Corpus Callosotomy: Is the severing the network of neural connections between the right and left halves, or hemispheres, of the brain.

Primary candidates are children with severe seizures that start in one half of the brain and spread to the other side.

The initial surgery may cut the forward two-thirds of the corpus callosum, leaving the rest intact. If this does not provide sufficient seizure control, the remaining portion may be cut.

A corpus callosotomy may be performed when partial seizures secondarily generalize and it is not possible to identify a single epileptic focus or when resection of a localized focus would cause a pronounced neurological deficit.

Uncontrolled generalized seizures, especially atonic seizures (drop attacks), may also be treated with this type of surgery. The usual aim of callosotomy is to reduce seizure frequency.

However, the goals of corpus callosotomy differ from those of resective surgery, in which a seizure-free outcome is more likely and expectations are higher.

Multiple Subpial Transection (MST): This operation seeks to control seizures by cutting nerve pathways.

To put it simply, vertical connections between nerves cells are thought to be associated with normal brain function, while horizontal connections appear to help seizures spread.

 Subpial Transections involve cutting the horizontal connections to prevent seizures from spreading. This relatively new procedure can limit seizing and help protect functionally important regions of the brain.

It is used when the seizure focus is located in a vital area of the brain that cannot be removed, such as the speech area.

Instead of taking out the affected tissue, the surgeon severs the parallel connections between cells in the affected area.

A series of shallow cuts (transections) in the brain tissue are cut – those that are designed to prevent seizures from spreading into other parts of the brain, leaving the person’s normal abilities intact.

This relatively new procedure can limit seizing and help protect functionally important regions of the brain.

About 70% of patients who undergo a MST have satisfactory improvement in seizure control. Particularly those with partial (focal) seizures.

Hemispherectomy and Hemispherotomy: This most radical type of epilepsy surgery removes half of the brain’s cortex, (hemisphere), or outer layer.

With a functional hemispherectomy, one hemisphere is disconnected from the rest of the brain, but only a limited area of brain tissue is removed.

This surgery generally is limited to children younger than 13 years old who have one hemisphere that is not functioning normally.

While it seems impossible that someone could function with only half a brain (the other side fills up with fluid), children manage to do so because the half that remains takes over many of the functions of the half that was removed.

In fact, children often recover very well from the procedure, and their seizures usually cease altogether. The chance of a full recovery is best in younger children.

 About 85% of people who have a functional hemispherectomy will experience significant improvement in their seizures, and about 60% will become seizure-free.

Misperceptions and misunderstandings about surgery are common.

While it is vital to have an accurate picture of potential complications, it is also important to dispel unfounded fears. Similarly, it is critical to have realistic expectations.

Many patients worry that removing a portion of their brain will change their personalities or who they are, but this is very rarely the case.

For most people with uncontrolled epilepsy, the area of the brain that causes seizures is not functioning properly anyway.

Since it is not doing what it should be doing, removing it is usually safe. Furthermore, electrical activity arising in the brain’s seizure focus often impairs the functioning of other brain areas.

Yet, depending on the type of surgery, more than 60% of patients can become seizure free and 90% can enjoy a significant reduction in their seizure activity.

Many patients report that, in addition to experiencing fewer seizures, they have an improved quality of life due to reduced depression and reduced medication burden.

Of course, there are worst case scenarios, like death, which occurs in less than 1 out of 1,000 cases. Or simply, maybe the surgery won’t work. Or turn out as you had hoped and expected.

But, ultimately, brain surgery is a brave and scary decision — albeit one with calculated risks. Only you can decide whether the benefits outweigh the risks. And grab that brass ring!

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Other articles of interest:

Researchers Report On Safety of Rapid AED Withdrawal in Pre-Surgical Monitoring http://www.sciencedaily.com/releases/2013/12/131208090246.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28ScienceDaily%3A+Health+%26+Medicine+News+–+Epilepsy+Research%29

Brain Stimulation Device Demonstrates Safety, Seizure Reduction http://www.sciencedaily.com/releases/2013/12/131208090333.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28ScienceDaily%3A+Health+%26+Medicine+News+–+Epilepsy+Research%29

Progress in the Prediction of Epilepsy Surgery http://www.sciencedaily.com/releases/2013/10/131002092139.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28ScienceDaily%3A+Health+%26+Medicine+News+–+Epilepsy+Research%29

Predicting Surgical Outcome for Epilepsy Patients http://www.medicalnewstoday.com/releases/263596.php

Brain Surgery – Questions to Prepare Yourself https://epilepsytalk.com/2012/04/12/brain-surgery-questions-to-prepare-yourself/

Children’s Brain Surgery…Preparing YOUR Child… https://epilepsytalk.com/2012/04/22/preparing-your-child-for-brain-surgery/

The Trouble with AEDs https://epilepsytalk.com/?s=the+trouble+with+AEDs

Vagus Nerve Stimulation…Is it for YOU? https://epilepsytalk.com/2011/03/13/vagus-nerve-stimulation%E2%80%A6is-it-for-you/

TNS vs. VNS – NO SURGERY! https://epilepsytalk.com/2013/03/24/trigeminal-nerve-stimulation-a-breakthrough-technology-reducing-seizures-by-up-to-66/

The Gamma Knife — Non Invasive Surgery https://epilepsytalk.com/2012/09/12/the-gamma-knife-non-invasive-surgery/

Laser Surgery — New Breakthrough Epilepsy Treatment! https://epilepsytalk.com/2011/07/19/breakthrough-surgery-for-those-with-epilepsy/

Responsive Neurostimulation (RNS) Shown to Reduce “Untreatable” Seizures https://epilepsytalk.com/2013/05/05/responsive-neurostimulation-rns-shown-to-reduce-untreatable-seizures-3/

Trigeminal Nerve Stimulation — A Breakthrough Technology Reducing Seizures by Up to 66% https://epilepsytalk.com/2013/03/24/trigeminal-nerve-stimulation-a-breakthrough-technology-reducing-seizures-by-up-to-66/

Brain Connectivity Can Predict Epilepsy Surgery Outcomes http://www.sciencedaily.com/releases/2013/10/131030185157.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28ScienceDaily%3A+Health+%26+Medicine+News+–+Epilepsy+Research%29

Resources:
http://www.epilepsiemuseum.de/alt/caesaren.html
http://www.aesnet.org/go/press-room/consensus-statements/va-statement
http://www.internationalbrain.org/?q=node/121
http://eacfcms.memberfuse.com/post-traumatic-stress-epilepsy
http://www.medicalnewstoday.com/articles/195223.php
http://newsfeedresearcher.com/data/articles_m30/epilepsy-brain-injury.html
http://www.traumaticbraininjury.com/
http://www.nlm.nih.gov/medlineplus/traumaticbraininjury.html
http://www.internationalbrain.org/?q=node/121
http://www.sciencedaily.com/releases/2013/10/131030185157.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28ScienceDaily%3A+Health+%26+Medicine+News+–+Epilepsy+Research%29


21 Comments »

  1. Phylis,,, THIS ONE IS VERY CRUCIAL SUPER INFORMATION 🙂 🙂 🙂
    Lady,,, You ALWAYS amaze me, with questions, answers & DETAILED DESCRIPTION of the ordeal, DIAGNOSIS, potential benefits, advantages & disadvantages of the potential remed\y, my “Doctors” could CARELESS to explain.
    KNOWING IS A WHOLE BETTER, THAN LAYING ON YOUR BACK AT SURGEON’S BED, GUESSING & HOPING, THE SURGEON KNOWS WHAT’S HE/SHE DOING.
    Thanks for your hard work, time & resources in devoting to research this option.

    Phylis,,, You got my admiration & a NOBLE PRIZE for this one, Cheers :-):-):-)

    Like

    Comment by Gerrie — May 22, 2013 @ 11:43 PM

  2. Hi Gerrie, you are so right, doctors think that they know it all and therefore do not have to explain anything to us.

    I would never have surgery on my brain because I have had a couple of fractures in the past. My doctors have never suggested it and that is probably why.

    I always do research on my own about what a doctor is going to do to me, that includes the meds that I take.

    I knew someone who had a lobectomy a long time ago.

    The doctors accidentally ?? cut away his speech part of the brain. He wound up in a convalescent home in a wheelchair. He had his own room and got out and went around the home until a nurse caught him and put him back in his room. He was young, a teenager. His parents must have put him there.

    If they loved him, they would have taken care of him at home. that is sad. );

    I have not heard of a TNS before, I will check into it since I have had so many falls. The trouble is, I do not have a warning all of the time. It would be worth it for the times that I do.

    Like

    Comment by Ruth — May 23, 2013 @ 6:43 AM

    • What an awful story. And yes, concussions are scary. I’ve just gotten over my last one which happened three months ago.

      Yes, I’ll have the obligatory MRI, but what are they going to say “You’ve had a concussion.” (Duh!)

      The only thing that worries me is the cumulative damage.

      Like

      Comment by Phylis Feiner Johnson — May 23, 2013 @ 8:22 AM

  3. I have always been curious about the possibility of brain surgery, and had no idea that it was possible for a person who suffers generalised siezures such as myself! I might investigate further, except that I really wouldn’t want my head to be cut open whilst awake (and I understand that this is the normal procedure).

    Thanks for the information!

    Like

    Comment by Missus Tribble — May 23, 2013 @ 6:47 AM

  4. I doubt you’d be aware of it because of all the twilight drugs.

    But, if you’re not conscious, they can’t gauge your reactions and response. Then you’d really be cooked.

    Like

    Comment by Phylis Feiner Johnson — May 23, 2013 @ 8:25 AM

  5. Brain surgery today, piece of cake. I have a horse shoe size incisions on the left side of my head where they took out a giant tumor. It was easy, you quickly go through all of the good and bad you did in your life then u give yourself up to the surgeons to do what they do and that’s to operate. Sure accidents can happen, u can also get hit by lightning or with the power ball jackpot. Not perfect, but if operation can heal you i’m all for it. I had no choice, it was operate or go into a coma eventually. I said operate please. Luckily the tumor was only a type II so it was on the fence as to wanting to be cancerous or not. My operation was supposed to be at 3pm, well they get me ready and i’m in the hall way just waiting in bed. Then a nurse comes to me and says that the surgery will be delayed due to complications of the surgery before. You can imagine the thoughts that ran through my head at that time. COMPLICATIONS: Oh know, get me out of here. DOH The song What will be will be” kept coming to my mind. And like the song said i let the future proceed in the hands of the surgeon.

    The worst part was the emobolization, where they put a tub through ur leg, near the crotch area in the veins, then move it to where the tumor is and then inject something to stop the flow of blood that goes to the tumor for that vain, and repeat for the rest of the veins.

    Overall i think they did very well, i’m still here and able to live and enjoy each day. I’ve been left with seizures since the removal of the tumor, but still even that is better then the alternative. I had asked my nuoro if a second brain surgery for the seizures would help, he said no. But what can i expect with the remove of a foreign element the size of a baseball growing in my head.

    Isn’t life amazing. Especially the art of surgery!!

    AS always, thanks for showing use ur homework phylis, well researched. Hip Hip hooray!!!!!

    Like

    Comment by Zolt — May 25, 2013 @ 12:57 AM

  6. And hip, hip, to you Zolt, for your bravery and positive attitude.

    I’m sure glad you’re still with us!

    Like

    Comment by Phylis Feiner Johnson — May 25, 2013 @ 10:02 AM

  7. Hi Zolt, glad that you are all right. Brain surgery can be scary, but it sounds like you came through okay.

    Hi Phylis, The reason that you have a CTscan or Mri anyway, is to see if you got a fracture in your brain. I had a fracture and I did not even know it. I still do not feel it. that puzzles the doctors.

    Like

    Comment by Ruth — May 30, 2013 @ 3:32 PM

  8. Yup, I’ll probably be having an MRI (because of my concussion) sometime after I go to the neuro on Tuesday.

    Like

    Comment by Phylis Feiner Johnson — May 30, 2013 @ 5:03 PM

  9. Thanks, Ruth. Yes I came through it ok, just like the theory that computer info doubles every 5 yrs, i think that surgery also does. The oldest movie i’ve seen on tumors was with Bette Davis who had surgery for brain tumor and made it ok, that movie was made back in 1940. So i believe that surgery today is quite advanced. A lot of people have go through it. The fear of surgery is actually worse than the surgery.

    Like

    Comment by Zolt — June 10, 2013 @ 4:59 PM

  10. Zolt, They noticed I tiny tumor below my lobes. I have had it since birth. I have had 2 surgeries to control the seizures. My Epileptologist and Neurosurgeon said I have been tough, I don’t know about that I do the best I can. The medicatioin seems to moderate the seizures but don’t understand why I am not under control. They feel with the latest MRI and EEG they will be able to detect if anymore can be done. It will be interesting.

    Like

    Comment by Toni Robison — June 25, 2013 @ 8:47 AM

  11. Why haven’t they removed it Toni? Do they feel the surgery would be too risky?

    Like

    Comment by Phylis Feiner Johnson — June 25, 2013 @ 9:06 AM

  12. My son had the MST surgery at age 5 over 20 years ago at Rush Presbyterian St. Lukes Medical Center in Chicago. His doctors Whisler and Morrell pioneered the MST procedure He was the second child with Landau Kleffner Syndrome to have the surgery. Thank the Lord that I chose surgery. I have watched as many children with the same disorder have grown up and they are mentally retarded, must live in group homes, are uncontrollable, have speech difficulties, etc. My son graduated college and has a wonderful career as a Computer Programming Engineer, lives on his own, drives, is social and out going etc. He takes no medications. These are things I did not dare to hope for when he was younger. It works!!!

    Like

    Comment by Jane Rudick — July 16, 2013 @ 2:17 PM

    • CONGRATULATIONS JANE,,, !!!
      You are a hero, for having the guts to risk it all.
      You nurtured the boy to become, worthy man.
      Your story is very inspiring, to motivate many others like me, to take the risk in overcoming this nightmare.
      Thank you for sharing your story.

      Like

      Comment by Gerrie — July 16, 2013 @ 8:57 PM

      • Hi Gerrie: I am no hero. I am just a mother who wants the best for her kids. That means doing your homework too. Reading epilepsy journals and medical dictionaries and books and asking questions until you can understand the lingo, know what each test means or rules out and test limitations, possibilities. It means going to a teaching hospital with the latest of technology and finding doctors with the highest possible experience and ones that care. It means making physicians take notice that your son is not just a 10 minute appointment but someone to think about and care about when the appointment is over. And the most important thing is that you must have enough knowledge to be able to ask the right questions in order to get the best help. I was a young, shy little Southern girl but I learned to speak up to advocate for my son. He had 10 different diagnosis before the right one. He lost years of learning before he had the surgery and he had lost speech and hearing and his behavior was autistic like. I had a simple belief. He was okay and something broke and if I could find and fix it then he would be able to relearn and be better. The surgery was not bad at all. He was home in less than a week. After surgery I still had no guarantee that he would be okay so we worked. I used a multimodal aphasic technique to help him learn faster and catch him up with his peers. I insisted on a regular classroom and used school as a babysitter and myself as the one responsible for his education rehabilitation. Each life level I rejoiced…saying a sentence, ordering by himself at McDonalds, playing baseball, going to junior high, driving, graduating high school and college, getting a career job and now I am anxiously waiting for marriage and grandchildren. I would love to hear from any parents of children with LKS.

        Like

        Comment by Jane Rudick — July 17, 2013 @ 10:00 AM

  13. Jane, that’s the best news I’ve heard all day!

    But as neurologist Patricia E. Penovich, MD, of the University of Minnesota and the Minnesota Epilepsy Group says: “epilepsy patients who are candidates for surgery or other non-drug treatments should be considered for these procedures earlier rather than later.”

    So I guess your bravery and courage showed you the way for your son’s quality of life!

    Like

    Comment by Phylis Feiner Johnson — July 16, 2013 @ 2:47 PM

  14. Is there any research on long term outcome for patients who have had partial hemisphereictomy?

    Like

    Comment by Rebecca — September 30, 2014 @ 4:54 PM

  15. Studies have found no significant long-term effects on memory, personality, or humor,[4] and minimal changes in cognitive function overall.[5]

    For example, one case followed a patient who had completed college, attended graduate school and scored above average on intelligence tests after undergoing this procedure at age 5.5.

    This patient eventually developed “superior language and intellectual abilities” despite the removal of the left hemisphere, which contains the classical language zones.[6]

    When resecting the left hemisphere, evidence indicates that some advanced language functions (e.g., higher order grammar) cannot be entirely assumed by the right side. The extent of advanced language loss is often dependent on the patient’s age at the time of surgery.[7]

    Along with neuroplasticity, people who undergo hemispherectomies remarkably recover due to resilience.

    Resilience is the ability, in this case, of the brain being able to recover from a tough situation and take back its shape.

    Neuroplasticity resilience explains why the hemisphere that is still intact is able to recover many of the functions that were once the removed hemisphere’s job.

    Resilience here is an action in patients with hemispherectomies in which they recover and navigate back to health.[8]

    Although initially thought to be limited solely to children, a study in 2007 indicated the long-term efficacy of anatomic hemispherectomy in carefully selected adults, with seizure control sustainable over multiple decades.

    http://en.wikipedia.org/wiki/Hemispherectomy

    Like

    Comment by Phylis Feiner Johnson — September 30, 2014 @ 6:41 PM

  16. I had the surgery about 20 years ago because I was having so many and they came from the left side, they found when they got in they could only take out a certain amount of damage because my memory on my left side was good but my right side I didn’t have any. They found this during the surgery. Since I still have a lot but I am always aware during them, but sometimes it would be nice to not to be because alot of them are fear from the left side. I am still on a lot of drugs but I have about 15 to 20 a month or more! My son really wants me to try this marijanu!!!

    Like

    Comment by Karen Hall — January 10, 2015 @ 2:35 PM

  17. I’m in favor of medical marijuana and so are thousands of others. There are dozens of articles to support that decision such as:

    Medical Marijuana — It’s Here To Stay

    https://epilepsytalk.com/?s=marijuana

    Medical Frequently Asked Questions

    http://norml.org/marijuana/medical/item/medical-

    frequently-asked-questions

    Dr. Sanjay Gupta’s pot confessional gets global headlines

    http://www.cnn.com/2013/08/09/health/gupta-weed-reaction/

    And that’s just the very tip of the iceberg. Google Medical Marijuana — Positives and you’ll literally find hundreds of articles.

    Good luck with your decision.

    Like

    Comment by Phylis Feiner Johnson — January 10, 2015 @ 3:32 PM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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