Epilepsy surgery

 Overview: 

Epilepsy surgery is a surgical procedure that focuses on the removal of a section of the brain that causes seizures. However, the surgery gives the best results when seizures happen in a single area of the brain and is a good option when non-surgical interventions like anti-seizure medication have not worked to control seizures. The doctor may perform multiple tests to decide whether epilepsy surgery is a viable option for the patient and what type of surgery they may require. 

Understanding Seizures: 

Seizures are a series of uncontrolled, sudden electrical impulses that occur between the brain's nerve cells. These activities can disturb the transmission of messages between the brain cells and cause involuntary changes in the body's functioning and behavior. It is important to note that every brain has the potential to go into a seizure. However, a person whose brain has a low seizure threshold has a higher chance of having seizures as compared to others who don't have epilepsy. The aim of epilepsy surgery is to stop the seizures or reduce their severity. 

Symptoms of seizure include: 

• Changes in the awareness of the surroundings. 
• Twitching or jerking in the muscles. 
• Changes in mood, behavior, emotions, and physical sensations. 

The complications that seizures cause are: 

• Physical injuries to the body during a seizure 
• Drowning, if the seizure happens while taking a bath or swimming. 
• Depression and anxiety. 
• Delays in development in children 
• Degradation of memory and other critical analytical and thinking abilities. 
• Death in rare cases. 

How Does Epilepsy Surgery Help: 

• Surgery helps the removal of the portion of the brain that is the cause of the seizures.  
• The procedure facilitates the disconnection between the brain nerve cells to avoid all communication between them and block the spread of seizures to other areas of the brain.  
• The technique helps heat and kill the nerve cells responsible for the seizures by using a laser. 
• Epilepsy surgery involves the use of pacemaker-type instruments and electrodes that transmit electric signals to stop the seizure activity from the source. 
• The procedure also effectively includes inserting electrode wires through robotic guidance to detect and record seizure activity in the deep areas of the brain. 

Types Of Epilepsy Surgeries: 

The type of surgery required depends on where the neurons that initiate the seizures are located and the age of the person. 

• Resective surgery: This type of surgery is a standard and common procedure that removes a small section of the brain. The surgeon separates the tissue of the brain from the area where seizures happen. That is where there is either a tumor, injury, or some malformation. Respective surgery is mostly conducted in the temporal lobe, which is in charge of visual memory, language understanding, and emotional control. 
• Laser interstitial thermal therapy (LITT): This type of surgery uses a laser to focus on and destroy a small section of the brain. Hence, it is considered to be less invasive than resective surgery. Magnetic resonance imaging (MRI) is used to direct the laser to the targetted area. 
• Deep brain stimulation: This type of surgery uses a device placed permanently in the deep area of the brain. This device regularly transmits timed electric impulses and signals that block the seizure-causing activities. The procedure of implanting the device is guided by the MRI technique, and the generator that generates and sends the electric impulse is placed in the chest. 
• Corpus callosotomy: This surgery is used for entirely or partially removing that portion of the brain which connects nerves on the right and left sides of the brain. This section is called the corpus callosum. This surgery is preferred for children who face irregular brain activity that radiates from one end of the brain to the other. 
• Hemispherectomy: This procedure involves the removal of one side of the brain, known as the cerebral cortex. This surgery is suitable for children who experience seizures that erupt from multiple areas in one single hemisphere. This kind of activity is caused by a condition at birth or in the early period of infancy. 
• Functional hemispherectomy: This surgery is performed on children and includes the removal of the connecting nerves without removing any portion of the brain. 

The Procedure: 

• The doctor assesses the person's eligibility for surgery, identifies the area of surgery, and gets a detailed understanding of how that area of the brain works.  
• An image is taken and enlarged for further study of the surgical site. 
• Standard procedures like Baseline electroencephalogram (EEG), Positron emission tomography (PET), Video EEG, Invasive EEG monitoring, Magnetoencephalography (MEG), functional MRI, Single-photon emission computerized tomography (SPECT), and other neuropsychological tests are deployed to find out the source of the disrupted brain activity. 
• The hair at the surgical site on the skull is cut, cropped short, or shaved to avoid infection during the procedure. A small, soft tube is placed inside the vein to provide IV fluids, anesthesia, or other medicines during the surgery. 
• The vitals of the patient are constantly monitored. An EEG monitor records the brain waves during the operation to identify the portion where seizures start. 
• Anesthesia is administered to put the person to sleep. In rare cases, the doctor may awaken the patient to determine which part of his brain controls which activity. When the person is awakened, medicines are administered to kill the pain. 
• A small gap is made in the skull during the surgery, which is sealed after the procedure. 
• The patient is required to stay in the recovery room till the effects of anesthesia wear out. For the first night, they are placed in the intensive care unit (ICU) and later in the regular room for around three days.  
• It is usual for the head to be swollen and painful after the procedure. Medication and ice packs help to control the swelling within a few weeks. 
• Patients are advised to not resume everyday work and other activities for one to three months and to rest sufficiently before resuming physical activity. 
• Rehabilitation is not needed if any complications don't arise during the surgery. 
• The most favorable outcome of epilepsy surgery is seizure control with medication. 
• If there are no seizures for one year, the doctor reduces the anti-seizure medicine and eventually stops it.  

Risks Involved: 

Since different parts of the brain control different functions, the risks will also depend on the portion of the brain that is operated on. The risks include: 

• Developing memory, speech, and language problems. 
• Visual impairment 
• Depression and other emotional issues. 
• Headache 
• Chances of stroke.  

Additionally, the other complications that can develop are: 

• Developing a reaction to anesthesia that is given. 
• Bleeding and infection at the surgical site. 
• Damage to the tissue. 
• Slow healing at the site of the incision. 

Conclusion: 

 If non-surgical interventions for epilepsy haven't been successful, then epilepsy surgery is a good option to stop the seizures and reduce their frequency. There are multiple benefits that include lesser requirement of medications, better chances of resuming daily activities, and decreased complications like depression, etc.  

However, one needs to understand the risks and have a detailed discussion with the doctor before making the final decision for the best possible outcome. 

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