Epilepsy Surgery

Epilepsy is a neurological disorder caused by abnormal electrical activity in the brain. Affecting millions of people worldwide, epilepsy represents a significant health issue for treatment-resistant cases. While most epilepsy cases can be controlled with medication, some patients may not respond effectively to drugs. In such cases, surgical treatment becomes an option. Epilepsy surgery is a method applied to control seizures in epilepsy cases that cannot be managed by medications.

Objective and Indications for Epilepsy Surgery

The main goal of epilepsy surgery is to permanently eliminate or reduce the intensity of seizures. This surgical intervention is particularly used for cases of drug-resistant epilepsy, where medication does not provide adequate control. Epilepsy surgery is generally considered in the following situations:

1. Drug-Resistant Epilepsy: If the patient’s seizures continue despite regular medication use, surgical intervention may be considered.
2. Seizures Affecting Quality of Life: When seizures significantly impact the patient’s quality of life and cannot be controlled with medication, surgical options are explored.
3. Identifiable Seizure Foci: For surgery to be considered, the source of the seizures must be clearly identifiable.

Methods of Epilepsy Surgery

Epilepsy surgery includes several methods, with the most suitable approach chosen based on the source, type of seizures, and overall health of the patient.

1. Temporal Lobectomy
   The most common type of epilepsy surgery. The source of abnormal electrical activity in the temporal lobe is surgically removed. The temporal lobe is the brain region where seizures frequently begin, and lobectomy is highly successful in such cases. The success rate of this method can vary depending on the type of seizures and brain structure.
2. Focal Lesion Resection
   Focal lesion surgery is the surgical removal of pathological tissue in the brain that is causing seizures. It is used to remove abnormal brain tissue such as focal cortical dysplasia and is a highly successful method.
3. Neuromodulation (Vagus Nerve Stimulation – VNS, Deep Brain Stimulation-DBS)
   Brain stimulation therapy is a method used for patients with epilepsy who are not suitable for resective surgery. With this method, epileptic activity is tried to be regulated by electrical stimulation. Neuromodulation is highly effective in reducing the frequency of epileptic seizures, but it does not guarantee complete cessation of seizures.
4. Ketogenic Diet
   Though not a surgical method, the ketogenic diet is another treatment option that may be effective for some patients. This diet is high in fats and low in carbohydrates, and it may help balance electrical activity in the brain.
5. Stereotactic Laser Ablation
   A newer method, stereotactic laser ablation targets and eliminates abnormal brain tissue using a laser beam. This procedure is minimally invasive and can speed up the recovery process.

Post-Surgical Monitoring and Risks

Post-surgical monitoring is crucial for a successful recovery. Since complete seizure elimination is not guaranteed, patients must be regularly monitored. Additionally, the risks associated with surgery should be considered. These risks may include brain tissue damage, infection, bleeding, and neurological disorders.

Success Rate and Quality of Life

The success rate of epilepsy surgery depends on the type of surgery, the patient’s overall health, and the source of the seizures. However, for many patients with drug-resistant epilepsy, surgery has successfully controlled seizures and significantly improved quality of life. Most patients require less medication post-surgery and experience a significant improvement in their quality of life due to reduced seizures.

Epilepsy surgery offers a promising option for patients with drug-resistant epilepsy. However, before deciding on surgical intervention, a thorough evaluation between the patient and doctor must be conducted. Epilepsy surgery can be an effective treatment for suitable patients, but successful outcomes may not always be achieved. Therefore, a surgical approach to epilepsy treatment should be meticulously planned by a multidisciplinary team.