Epilepsy Surgery - Procedure, Types, Benefits & Recovery

Surgeons remove or alter the area of the brain where seizures originate during epilepsy surgery. Doctors consider it when a minimum of two anti-seizure medications have failed to reduce seizures. Additionally, the patient must experience recurring attacks for six months or more.

When we were evaluating epilepsy surgery, we learned that the decision depends on various factors, such as:

1. Location of the seizure focus

2. Extent of the epileptic tissue

3. Individual's overall health

Anatomy and Physiology of the Human Brain 

The human brain, a complex organ, controls most body activities and processes and makes decisions for the body. It has three main parts:

1. Cerebrum: Responsible for higher brain functions like thought, action, and sensory processing.

2. Cerebellum: Coordinates voluntary movements, balance, and posture.

3. Brainstem: Controls essential life functions such as breathing, heart rate, and blood pressure.

Types of Epilepsy Surgeries

Epilepsy surgery involves various procedures based on the condition of the patient. Here are the main types of epilepsy surgeries:

The procedure is recommended for patients with drug-resistant epilepsy. Doctors also suggest it for patients diagnosed with some epileptic syndromes and anatomical anomalies (internal issues) of the brain.

1. Medically Refractory Epilepsy: Involves seizures that do not respond to anti-epileptic drugs (AEDs) despite optimal treatment.

2. Temporal Lobe Epilepsy (TLE): The most common kind of epilepsy treated with surgery, often involving the removal of the seizure focus in the temporal lobe.

3. Lesional Epilepsy: It is caused by brain lesions such as tumours and vascular malformations.

4. Sturge-Weber Syndrome: A rare disorder characterised by abnormal blood vessels on the surface of the brain.

5. Cortical Dysplasia: Congenital abnormality where the cortex of the brain develops abnormally, leading to seizures.

6. Hemimegalencephaly: Condition where one hemisphere of the brain is abnormally large and dysfunctional.

7. Rasmussen Syndrome: Rare, chronic inflammatory neurological disease that causes severe seizures.

8. Porencephalic Cyst: A cystic cavity within the brain that can cause seizures. 

Who is a candidate for epilepsy surgery?

Epilepsy surgery is not typically the initial treatment option recommended by doctors. However, it may be considered for individuals who meet the following criteria:

1. Anti-epileptic medications do not adequately control seizures

2. It originates from a single, identifiable area of the brain

3. Removal of the seizure focus is unlikely to cause neurological deficits

The primary benefit of epilepsy surgery is the potential for significant reduction or complete removal of seizures. Successful surgery can lead to:

1. Improved quality of life

2. Reduced risk of injury from seizures

3. Decreased need for anti-epileptic medications

4. Enhanced cognitive function and memory

5. Increased independence and ability to participate in daily activities

Patients must follow specific guidelines before epilepsy surgery to ensure the procedure goes smoothly. These preparations include assessments, risk evaluations, and restrictions to optimise surgical outcomes.

On the day of Epilepsy Surgery

Patients must complete several steps to prepare for the procedure. This includes final health checks, consent formalities, and ensuring the patient is in the correct position for surgery.

Epilepsy surgery involves several critical steps to ensure the procedure is effective and safe. Here are the general steps that a neurosurgeon follows:

1. Anaesthesia Administration: The patient receives general anaesthesia to ensure they are asleep and pain-free during the surgery.

2. Craniotomy:  The surgeon removes a small part of the skull to expose the brain.

3. Seizure Focus Identification: Doctors may place electrodes on or inside the brain to identify the area causing seizures.

4. Surgical Procedure: Depending on the surgery type, the surgeon removes the seizure-causing brain tissue (resective surgery) or disconnects pathways to prevent seizure spread (disconnection surgery).

5. Closure and Recovery: The skull bone is replaced, and the incision is closed. The patient is then moved to a recovery area for monitoring.

The recovery time post-surgery varies depending on the type and extent of the procedure. In general, patients can expect the following:

Recovery at Hospital

In most cases, the patients are moved directly to the ICU after the surgery. The average hospital stay after epilepsy surgery is a minimum of 3-4 days. During the stay, a patient can expect:

1. Initial Monitoring: After surgery, patients are taken to a recovery room. The medical team closely observes them for several hours to ensure they wake up properly from anaesthesia.

2. Pain Management: Medication mitigates discomfort. Patients may experience headaches, nausea, and swelling around the surgical site.

3. Vital Signs Check: Nurses check blood pressure, heart rate, and oxygen levels to ensure stability.

4. Early Mobilisation: Movement in the body promotes blood circulation and prevents complications like blood clots.

Recovery at Home

After discharge from the hospital, the patient must also be cautious at home. The average epilepsy surgery recovery time can extend up to a month. During this time, the patient should be mindful about:

1. Wound Care: Ensuring to keep the surgical site clean and dry. Instructions must be followed for dressing changes.

2. Medication Adherence: Continue taking the prescribed medicines, including anti-seizure drugs, as directed by the doctor. Consult a healthcare provider before changing dosage.

3. Activity Restrictions: Avoid exhausting activities and heavy lifting. Gradually increase physical activity as advised by the doctor.

4. Rest: It is normal to feel tired and need more sleep than usual during the recovery period. Ample rest should be provided to the patient.

5. Diet and Hydration: To support healing, maintain a balanced diet and stay hydrated. The patient must avoid alcohol and caffeine, as they can interfere with recovery and medication efficacy.

First Follow-up Appointment

The first follow-up consultation is scheduled for four weeks after the surgery. It is imperative for the following reasons:

1. Wound Check and Suture Removal: The first follow-up appointment is necessary to check the wound and remove any sutures or staples.

2. Assessment of Recovery: The doctor will assess the overall recovery, including any side effects or complications. They also evaluate the seizure activity and adjust medications if necessary.

The specific risks and side effects depend on the type and location of the surgery. Before proceeding with surgery for epilepsy, the medical team discusses the risks with the patient and their family. These may include:

1. Infection

2. Bleeding

3. Stroke

4. Neurological deficits (e.g., weakness, vision problems, memory loss)

5. Changes in mood or behaviour

When to call a doctor?

After epilepsy surgery, it is crucial to monitor the recovery and be aware of any signs that may require medical attention. Promptly contacting a doctor can help prevent complications and ensure a smooth recovery process. The complications include:

1. Signs of Infection: Redness, swelling, or discharge from the surgical site.

2. Seizure Activity: An increase in the number of seizures or new types.

3. Neurological Symptoms: New or worsening weakness, vision problems, or difficulty speaking.

Risks of Delayed Epilepsy Surgery

Delaying epilepsy surgery can lead to several adverse outcomes, particularly for patients with drug-resistant epilepsy. The longer the surgery is postponed, the more difficult it can become to manage seizures effectively. The major risks of delaying the procedure include:

1. Increased Seizure Frequency and Severity: Delaying surgery can result in more frequent and severe seizures, which can be harder to control over time.

2. Cognitive Decline: Prolonged uncontrolled seizures can lead to cognitive impairments, including memory loss and challenges with concentration and learning.

3. Higher Risk of Injury: Frequent seizures increase the risk of accidents like falls, burns, and drowning, which can have serious consequences.

The expenses of undergoing a surgical procedure can vary depending on various factors. While evaluating all the other things, it is necessary to determine how much does epilepsy surgery cost based on the condition of the patient.

Factors affecting the total expense of epilepsy surgery include:

1. Type of Surgery: Different types of epilepsy surgeries can incur different costs based on the complexity of the procedure. Vagal nerve stimulation is generally less expensive due to its less invasive nature.

2. Preoperative Assessments: Extensive preoperative evaluations, including MRI, EEG, and neuropsychological testing, contribute to the overall price. 

3. Hospital and Surgeon Fees: High-ranking hospitals and highly experienced surgeons typically charge more for their services.

4. Postoperative Care: Costs associated with postoperative care, including hospital stay, medications, follow-up visits, and rehabilitation, add to the total expense. 

Epilepsy surgery can significantly improve the quality of life for patients with drug-resistant epilepsy by reducing or eliminating seizures. However, it is essential to monitor your recovery closely and seek medical attention if any concerning symptoms arise. 

If you are looking forward to a successful epilepsy surgery, HexaHealth can assist you by providing access to experienced neurosurgeons and comprehensive care teams. Our experts offer personalised guidance tailored to each patient's specific needs.