Epilepsy Talk
Epilepsy and Brain Surgery — The Basics | May 27, 2020
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.
To subscribe to Epilepsy Talk and get the latest articles, simply go to the bottom box of the right column, enter your email address and click on “Sign me up!”
Resources:
https://www.webmd.com/epilepsy/guide/temporal-lobe-resection-epilepsy#2
https://www.everydayhealth.com/epilepsy/lesionectomy-surgery.aspx
https://www.webmd.com/epilepsy/guide/corpus-callosotomy#1
https://www.webmd.com/epilepsy/guide/multiple-subpial-transection-mst#1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066693/
20 Comments »
Leave a comment
About the author
Epilepsy Talk 
Goodmorning Phylis 😊. WOW!!!!! THANK YOU FOR THE INFORMATION!!!!!!! I really wish the neurologist would go over such surgeries with us in a complete detailed fashion and then the pros and cons of each before they place or placed that option in front of us while we sit/sat with them. However I was told it may not be an option now because of the concussions I have suffered. The last time I sat with the neurologist I asked about the VNS and mentioned that I have to take IBPROPHEN 600mgs daily now, but because of drug shortages I no longer get the ibprophen. He was upset that I wasn’t getting the ibprophen and quite surprised!! I did however mention there must be a way I can slowly get off of medication as a whole or at least bring the levels down. Funny how not all of them do eegs, sleeping and not sleeping, or mri’s like I’m used to having done. He went based on a C.T.Scan that was taken a few years prior then put me on toperimate and walked out. He said it was “focal seizures”. We know the rest, but thank you so much for finally properly taking the time to explain the different type of surgery. Please be well, stay safe and take care of yourself, Arthur and you cat 😊🦅💕
LikeLiked by 1 person
Comment by Kathy S.B — May 27, 2020 @ 11:11 AM
What about the VNS for you? Is it an open option, or one that’s being ignored?
Vagus Nerve Stimulation…Is it for YOU?
https://epilepsytalk.com/2011/03/13/vagus-nerve-stimulation%e2%80%a6is-it-for-you/
LikeLiked by 1 person
Comment by Phylis Feiner Johnson — May 27, 2020 @ 11:48 AM
I actually brought both up with the neurologist last year and he said for us to play a waiting game and we’ll see how everything is going the next time I go in. It’s pretty tough to deal with a doctor who’s supposed to be on our team when they absolutely put me through 4 months of sheer hell!!!!!!! And would not listen to me or properly read my file prior to meeting me for 10 minutes!! Kind of puts a bad/Leary feeling in a patient after all of that! And almost makes me just want to tough it out from here myself!! Better to be honest than to be sorry AND NOT REMEMBER ANYTHING AND HAVE TO BE PUT ON AN I.V.ANTIBIOTIC FOR 3 MONTHS AFTER!!!!!!!
LikeLiked by 1 person
Comment by Kathy S.B — May 27, 2020 @ 12:01 PM
Is another consult an option?
LikeLike
Comment by Phylis Feiner Johnson — May 27, 2020 @ 12:05 PM
Right now I’m not sure if I want to consult with that same neurologist to be honest with you. Not after what I went through meeting him the last time!!
LikeLiked by 1 person
Comment by Kathy S.B — May 27, 2020 @ 5:06 PM
No. I meant another, different neurologist.
LikeLiked by 1 person
Comment by Phylis Feiner Johnson — May 27, 2020 @ 6:37 PM
Oh I apologize Phylis I misunderstood 😕. Well I know my family doctor re-referred me to a female neurologist in the nearest city to me and I’m still waiting for a response to find out whether or not I’ve been referred to one or have one yet. That referral was sent in end of January 2020 and nothing yet. I’m still waiting.
LikeLiked by 1 person
Comment by Kathy S.B — May 27, 2020 @ 6:41 PM
Don’t just wait, Kathy. Speak up. Speak out. It’s not like you to be so quiet and accepting.
You know “the squeakiest wheel, gets more grease”? 🙂
LikeLiked by 1 person
Comment by Phylis Feiner Johnson — May 27, 2020 @ 6:46 PM
Fascinating article Phylis! I must say it is ironic (if that is the right word) that just as brain surgery may help people with epilepsy it can also cause epilepsy in people not suffering from it! I am thinking of the consequences of brain surgery for brain tumors and brain abscesses. In my case it was surgery for a misdiagnosed bacterial brain abscess in 1969 that lead to my developing epilepsy. Of course brain surgery for abscesses was a bit primitive in those days compared to now so the chances of feveloping such post operative nowadays are lower ( about 20%?)
Keep well
LikeLiked by 1 person
Comment by Michael H — May 27, 2020 @ 9:15 PM
Actually, I have a friend who was in the same boat as you. She had an invasive (benign) brain tumor that starting causing seizures.
Unfortunately, they botched the surgery (the tumor was like an octopus with tentacles surrounding her brain) and they nicked her executive functions.
She was rendered totally incapacitated, was in therapy for one year and left being just able to toilet herself and say dog.
But with years of cognitive therapy and a stunning amount of grit, five years later, she was 80 per cent functional.
Now, 10 years later she’s just about back to the old Sally. Still with memory impairments but 100 per cent better.
She’s like a phoenix rising from the ashes. A miracle of determination.
Except, because of her memory problems, she can no longer resume her practice as a psychologist.
And unfortunately, she still has seizures, infrequently, as a reminder of her nightmare.
LikeLike
Comment by Phylis Feiner Johnson — May 28, 2020 @ 9:50 AM
Goodevening Phylis 😊. Yes I will the minute I have an opportunity too!! In all honesty even my husband said “NO DARN ARE YOU GOING BACK TO HIM AFTER WHAT YOU WENT THROUGH!!!!!!!”. I just found my jacket from then and that was beginning of December 2019!!!!!!! However I guess my fear is I was wondering if I could even ask to be switched to a different neurologist in the city that he’s in now? JUST NOT HIM!!!!! Mainly because he really never did anything or ran any tests at all either!! I’ve just already had (if I am allowed to change neurologists) 2 neurologists who seem to be THE NOT VERY WELL EDUCATED AND MANNER ONE WHO DO NOT LIKE BEING ASKED ANY QUESTIONS?? Maybe they need to truly unseat without a patient do they really become a very good neurologist? I’m beginning to remember why I didn’t like neurologists now
LikeLiked by 1 person
Comment by Kathy S.B — May 27, 2020 @ 11:06 PM
I always like to see this subject mentioned because I am one who felt I was never going to have surgery as an option until an almost fatal car accident and viewing the surgery on TV prompted me to check it out. I remember everything I had to do to be a candidate for the surgery and have it done:
I had to convince my epileptologist and my family I can’t keep trying to control my seizures if there’s nothing permanent about the control.
I was going to have to spend almost a week in the hospital trying to have seizures so they could see where they were coming from. The whole time I was there I felt like a dog because they had me wired up and I could only go so far because I was connected to the wall. Riding a stationary bike, hyperventilating and sleep deprivation would be how they wanted to bring on the seizures. I got a break (if you think this is a break) when after having only one seizure the first five days and being told I may have to try this again later, I had three of the worst seizures I ever had that night. The last of these seizures came when my sons and wife came to pick me up so they got a good look at why I wanted surgery. The seizures were located locally in the left temporal lobe so I was a candidate.
Later they would run a WADA test to see what side of my brain controlled what (e.g. math, long-term memory, short-term memory) by deadening one side of the brain and later the other side by way of a shot through the groin. When all was said and done, they knew on the left side where I was having surgery, there was my math and short-term memory. I was never a straight-A student but I had a gift when it came to math so you’ll see where that played in the surgery.
I didn’t ask for this but I see how it would be a good idea for anyone who wants the surgery to ask about. My epileptologist gave me figures to show what the chances were of a successful surgery and how successful it could get: for me it was a 95% chance of better seizure control, 85% chance of total control BUT STILL TAKING medications, 70% chance of total control AND GOING OFF medications.
The day of the surgery came and I was excited and eager to have it done even though the nurses couldn’t believe how I felt. They put me under so they could start the surgery but after they opened up that side of my head, they woke me up. They told me they were going to deaden brain cells one at a time to see what controlled what. Each time they asked me to count to 25. Most of the time I could count with no problems but once in a while I’d say “1,2” and couldn’t say a word after that. Now they knew what part of my brain controlled my math so they could go around it as they removed a 3-inch cube of my brain.
About 12 hours after they put me in ICU, they were taking me to a room. My epileptologist said he had a few questions to ask me (Remember I said I had a gift with math). He asked, “What’s the square root of 7,450?” I couldn’t believe he asked that just after surgery but I thought about it and told him, “approximately 86.3”. He gave me the OK sign and actually I was mad about it. He left a part of my brain there because he wanted me to keep my math ability but did he leave a part that would create seizures?
Six months after surgery, we finally became good friends again because he told me the results of the eeg showed no activity. Almost 20 years after surgery and 14 years since I took my last pill, I’m doing fine and hoping anyone else who tries surgery receives the same results.
LikeLiked by 1 person
Comment by Ed Lugge — May 28, 2020 @ 12:06 PM
Wow, Ed. What a tortuous prep. It sounds much worse than the surgery itself.
But, look at where you are now. You are a walking, talking testament to grit, determination and success.
Thanks so much for sharing your story. I’m sure many will benefit from it.
LikeLike
Comment by Phylis Feiner Johnson — May 28, 2020 @ 1:12 PM
Thank you, Phylis. I just want to be an inspiration.
LikeLiked by 1 person
Comment by Ed Lugge — May 28, 2020 @ 4:12 PM
You certainly ARE an inspiration!!!
LikeLike
Comment by Phylis Feiner Johnson — May 28, 2020 @ 4:57 PM
Here’s a primer for those considering brain surgery:
Brain Surgery – Questions to Prepare Yourself
https://epilepsytalk.com/2019/04/19/brain-surgery-questions-to-prepare-yourself/
LikeLike
Comment by Phylis Feiner Johnson — May 28, 2020 @ 1:21 PM
I had a lobectomy in 2006 where a good part of my left temporal lobe was removed to allow access to the hippocampus, the center of my seizures. It took several years to recover but I’d do it again because of the benefits, including still being alive. The surgery is much easier now because it is done by a series of lazors that do little damage, except where they all come together. They can now burn away the damaged parts of the brain with little to no impact to the other parts. Recovery is much easier because the skull and temporal lobe are left in place and only a one night stay in the hospital is required.
LikeLiked by 1 person
Comment by Jon Sadler — May 28, 2020 @ 2:01 PM
For those who want to know more about laser brain surgery, here’s an article you might find interesting:
Laser Surgery — Breakthrough Epilepsy Treatment!
Thanks Jon, for your story and bringing to light a new option.
LikeLike
Comment by Phylis Feiner Johnson — May 28, 2020 @ 2:17 PM
Some happened to Your website. It won’t let me answer people for the last 24 hours.
LikeLiked by 1 person
Comment by Scotty — May 28, 2020 @ 2:20 PM
Scotty, I don’t know what the problem could be. Could you try another browser? Or resubscribe? I’m so sorry.
LikeLike
Comment by Phylis Feiner Johnson — May 28, 2020 @ 2:23 PM