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Specialists in the Field of Epilepsy Surgery
Information About the Field of Epilepsy Surgery
What Does Epilepsy Surgery Mean?
The disease epilepsy means an overexcitability of the cerebral cortex neurons, which leads to seizure-like potential discharges. Epileptic seizures manifest this with disturbances of consciousness. The seizures can manifest in very different ways, depending on the site of origin in the brain.
Epilepsy is defined as the occurrence of more than two epileptic seizures for which no other cause can be found. On the other hand, about 5 percent of the population experiences an epileptic seizure once in a lifetime, independent of the disease epilepsy. This is because fever, lack of sleep, addictive substances, and other factors can also be considered as triggers. Epilepsy is the most common chronic disease of the central nervous system.
The goal of therapy is freedom from seizures to improve the patient's life quality. Most patients can be well controlled with drug therapies and achieve this goal. However, some epilepsies are refractory to treatment in some cases and cannot be adequately treated with medication. So then, depending on the type of epilepsy, surgical therapy may be considered. Furthermore, some causes of epilepsy, such as tumors or structural changes in the brain, can be well localized and thus treated surgically with a reasonable success rate.
For Which Patients Is Surgery for Epilepsy an Option?
Most epilepsy patients can achieve freedom from seizures using drug therapies and do not need to undergo surgical treatment.
Focal epilepsies, i.e., epilepsies that affect only one localization in the brain and do not respond to drug therapy, can be treated surgically.
In contrast, this is not possible for generalized and multifocal epilepsies, forms that affect several areas or the entire brain.
The prerequisite for surgical treatment is the exact localization of the epileptogenic zone. This way, the triggering area can be reached and treated using surgical intervention. Furthermore, the epileptogenic area must not be overlapped by important brain areas. Otherwise, it cannot be removed entirely, and the surgical therapy in this way does not have a high probability of success.
What Surgical Procedures Are Used for Epilepsy?
Before the surgical intervention can take place, various diagnostic measures must be carried out so the focus of the disease can be localized more precisely. Diagnostically, this involves a video analysis to assess the symptoms during the epileptic seizure. A detailed medical history, especially with the help of relatives, can also provide information about the type of epilepsy. Finally, a neurological and psychological examination should also take place.
Furthermore, an EEG is carried out to assess the origin of the discharges more precisely. Stimulation techniques can provoke epileptic seizures, which can then be evaluated.
Magnetic resonance imaging can also be used to show altered brain areas and PET imaging to show brain metabolism.
The following procedures are available for surgical therapy. Resection surgery aims to cure the patient with subsequent freedom from seizures. The core of epilepsy can be removed, a so-called lesionectomy, and partial lobe removal, such as partial resection of the temporal lobe. The complete removal of a brain lobe or the interruption of the connection of the two brain hemispheres can also be performed. The surgeon's procedure is tailored to the patient using prior diagnostics and discussed in detail.
If a resection procedure is not feasible, it is possible to interrupt the propagation pathways of the epileptic discharges. This so-called disconnecting procedure can reduce the frequency and severity of seizures but not completely eliminate them.
The surgery is usually carried out under general anesthesia and requires several hours. In exceptional cases, surgery can also be carried out on an awake patient to assess brain areas and possible loss of function during surgery.
Epilepsy Surgery Experience
Surgical procedures for the treatment of epilepsy offer good chances of success if it has been possible to localize the area precisely beforehand. Overall, the chances of success in becoming seizure-free are about sixty percent. The best results are achieved in unilateral temporal lobe epilepsies, where a seventy to eighty percent success rate can be achieved.
Risks and Side Effects
Brain surgery comes with risks. These include injury to important brain structures with possible loss of function, which should be discussed with the patient beforehand. But natural surgical risks, such as post-operative bleeding and inflammation, can also occur. In addition, despite the procedure, the patient may not experience the desired outcome and will possibly be symptom-free after surgery.
Aftercare and Prognosis
Following the operation, the patient remains in the hospital for about a week, after which further treatment can take place in a rehabilitation clinic. Immediately after surgery, pre-existing medication can usually be reduced. However, the medication should not be discontinued until the patient has been seizure-free for about a year. Follow-up examinations with appropriate EEG diagnostics take place approximately every three, six, and twelve months after the operation.
Which Doctors and Clinics are Specialized?
Neurosurgeons perform surgical treatment in patients with epilepsy in close cooperation with the treating neurologists. Before surgery, an interdisciplinary case discussion is held with physicians from various facilities. These include neurosurgeons, neurologists, radiologists, and psychologists. The surgery and the stay take place in neurosurgical clinics; the neurologist usually carries out the follow-up examinations. Often there are dedicated epilepsy units that specialize in treating the condition.
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