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Epilepsy is one of the most common neurologic diseases in the world, and is present in up to 4% of the world's population. Treatment of epilepsy with medications is a major effort of the World Health Organization, as many patients with epilepsy never receive the treatment that would render them seizure free. Epilepsy surgery is even less likely to be considered in developed or developing countries because of a lack of resources or a lack of recognition by the physician that a treatable syndrome exists.
Surgery is an alternative for some people whose seizures cannot be controlled by medications. It has been used for more than a century, but its use dramatically increased in the 1980s and '90s, reflecting its effectiveness as an alternative to seizure medicines. The benefits of surgery should be weighed carefully against its risks, however, because there is no guarantee that it will be successful in controlling seizures.
Epilepsy surgery can be especially beneficial to patients who have seizures associated with structural brain abnormalities, such as benign brain tumors, malformations of blood vessels, and strokes.
Epilepsy treatment has evolved to include consideration of the patient's quality of life, not just the number of seizures. Both continued seizures and high doses of medication impose costs on all areas of a person's life - intellectual, psychological, social, educational, and employment. The individualized approach that should be used when prescribing seizure medicines is carried over to the surgical treatment of epilepsy. State-of-the-art technology is applied to perform the safest and least-invasive procedure that will help the patient to achieve the highest possible quality of life.
Surgical treatment of epilepsy is a treatment option in patients whose seizures are not responsive to medications or for patients who are unable to tolerate medication side effects. Medication may not also be the preferred treatment for patients whose seizures are caused by structural abnormalities in the brain.
Surgical removal of seizure-producing areas of the brain has been an accepted form of treatment for over 50 years when medicines fail to prevent seizures. However, because of new surgical techniques and new ways of identifying areas to be removed, more of these operations are being done now than ever before, and with greater success. Surgery can be performed on both children and adults. However, it is not a suitable treatment for everyone who has epilepsy, or for everyone with poor seizure control.
First line therapy for epilepsy involves treatment with antiepileptic medications. Most patients will respond to one or two different medication trials. The goal of this treatment is the elimination of seizures, since uncontrolled seizures carry significant risks, including injury and sudden death. However, in up to one third of patients with epilepsy, medications alone will be unable to eliminate seizures. In these patients, epilepsy surgery is considered.
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