FocusOn with Dr. Ahmed Sadek: Epilepsy and Surgery
When to consider surgery.
Epilepsy is a common medical condition estimated to affect 2.6 million Americans every year. In 2018, the CDC estimates that among those taking medication, only 44% report having their seizures completely controlled1. Epilepsy surgery is a viable alternative to patients who are unable to control their seizures through medications.
Before deciding on surgery, factors such as type and frequency of seizures, medication burden (including cost and side effects), and overall impact on quality of life need to be taken into account. Typically, surgery is considered as an option for patients whose seizures fail to be controlled on medications. It is recommended that a person try at least two or more seizure medications before considering surgery.
Although surgery has its risks, in well qualified patients it can have quite a high success rate of stopping seizures completely. Most people with epilepsy fear surgery and think of it as a "last resort", however several studies have found that early surgical intervention has greater long-term benefits. Most surgical risks are rare whereas continued frequent seizures pose daily risks of injuries, medication burden, and social/psychological impact.
The most important part of evaluation for surgical intervention is determining where in the brain the seizures originate from and then determining if you would benefit from a surgical intervention in this area. This is typically done through a combination of brain imaging, EEGs, and description of the patient's seizures. Those who have seizures caused by a structural brain defect (benign tumor, malformation of blood vessels, etc.) are often good surgical candidates. Typically, a patient will go to an "epilepsy monitoring unit" where they will have several days of EEG recording in order to determine where in the brain the seizures originate from. Most surgeries involve "resection" where part of the brain is removed by the surgeon although less invasive type surgeries involving lasers are also being used in select patients.
If you or a loved one are still having seizures despite taking medication, consider seeing an epilepsy specialist to discuss the possibility of surgery.
1Tian N, Boring M, Kobau R, Zack MM, Croft JB. Active Epilepsy and Seizure Control in Adults — United States, 2013 and 2015. MMWR Morb Mortal Wkly Rep 2018;67:437–442. DOI: http://dx.doi.org/10.15585/mmwr.mm6715a1
Dr. Ahmed Sadek
Orlando Epilepsy Center, Inc.
Dr. Sadek is the Director of Orlando Epilepsy Center. He is an Assistant Professor of Neurology at the University of Central Florida College of Medicine and a Clinical Assistant Professor of Neurology at the University of Florida Shands, Gainesville. Dr. Sadek is triple Board certified in Neurology, Clinical Neurophysiology, and Epilepsy.