Management of Epilepsy
Surgical
Most patients with epilepsy are treated with medication and the majority respond well. However, some will fail medical treatment. These patients should be referred to a specialized center with a comprehensive epilepsy program to be evaluated for epilepsy surgery.
Epilepsy surgery has been available as a treatment option for more than 50 years. This discipline is expanding and there are now multiple specialized centers throughout Canada with experience in selecting and treating epilepsy patients surgically. Although there are many different surgical treatments, the most common surgery for epilepsy is the removal (resection) of the anterior portion of the temporal lobe when the seizure focus is found within this structure. This surgical treatment has the best outcome. Indeed, a randomized controlled trial published in 2001 showed that epilepsy surgery is far better than medical treatment for people with temporal lobe epilepsy. Other forms of epilepsy can also be successfully treated with surgery, depending on the patient’s individual characteristics. There are also a number of other options, including various forms of stimulation therapy such as vagus nerve stimulation and deep brain stimulation.
If you are being considered for epilepsy surgery, a comprehensive evaluation is performed to ensure that the seizure focus has been correctly identified and is safe to remove surgically. This work-up may include
- Video-EEG monitoring, including capturing a typical seizure with EEG and video
- MRIs of the brain
- SPECT scan
- Neuropsychological testing
- Psychological evaluation
- Functional MRI
- PET scan
- Etomidate speech and memory testing
- Magnetoencephalography
For some patients the clinical history, scalp EEG, neuropsychological evaluation and MRI imaging are not able to accurately localize the seizure location within the brain. In scenarios such as this, invasive EEG recording methods, where electrodes are placed directly on or in the brain, may be used to identify which area of the brain generates seizures. These invasive techniques are part of the tools used by comprehensive epilepsy surgery programs across Canada.