Surgery for Treating Adult Epilepsy

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Who Should Consider Adult Epilepsy Surgery?

Epilepsy is a disorder that results from surges in electrical signals inside the brain, causing recurring seizures.

Usually, medication can bring seizures under control. However, in one-third of people with epilepsy, seizures persist despite trials of numerous drugs.

If two different medications cannot help control your seizures
, epilepsy surgery may be an effective option.

Determining if you're a candidate for epilepsy surgery

Before recommending surgery, neurosurgeons at the UPMC Movement Disorders and Epilepsy program must determine that:

  • Your seizures are continuing after trying two different medications.
  • Your seizures arise from one site in the brain.
  • The site of the seizures has been pinpointed.
  • The removal of the portion of the brain causing the seizures will not impair your ability to function.

Mapping brain function prior to surgery

Using state-of-the-art brain mapping imaging technology, UPMC neurosurgeons are able to determine the part of the brain responsible for seizures. After the area is found, neurosurgeons perform extensive testing to determine any major problems with speaking, understanding, or other abilities that could arise if that area of the brain is removed.

In some cases, neurosurgeons briefly interrupt the function of the part of the brain considered for surgical removal and ensure that you can still do all the things you can ordinarily do.

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Types of Adult Epilepsy Surgery

If surgery is appropriate for treating your epilepsy, UPMC neurosurgeons perform an array of effective surgical interventions

Resection of seizure focus

Using a combination of preoperative and intraoperative brain mapping, this procedure involves removing the area of the brain that is causing seizures. As the most common type of epilepsy surgery, people often experience a 50 to 90 percent success rate for complete seizure relief.

This procedure may also be effective for people who have epilepsy located in areas of the brain other than the temporal lobe, or for patients who have been told that their epilepsy is inoperable.

Multiple subpial transection

This procedure involves making small incisions in the brain to interrupt seizure activity. Neurosurgeons perform this type of epilepsy surgery when seizures originate in areas of the brain that they cannot safely remove. 

Vagus nerve stimulation

The vagus nerve serves as one of many highways of information for carrying messages to and from the brain. Because of its many connections to areas in the brain, the vagus nerve can be a key target for treating epileptic seizures.

During the procedure:

  • A vagus nerve stimulator (VNS) is implanted under the skin near the collarbone. A wire under the skin connects the device to the vagus nerve in the neck.
  • Neurosurgeons then program the device to produce weak electrical signals that travel along the vagus nerve to the brain at regular intervals. These signals help prevent the electrical bursts in the brain that cause seizures.

After the stimulator is implanted, a battery-powered device is programmed allowing patients to turn the device on if they feel a seizure about to start. People can also turn the device off if it is causing unpleasant side effects. 

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