In simple words, it is a problem with the brain's electrical system. Seizures occur because of disrupted brain activity giving rise to sensorimotor changes, or, changes in movement, behavior, feeling or awareness. Seizures in epilepsy may last for few seconds to a few minutes. They can commence at any age but it usually start in age group between 5-20 years. People who have had two or more seizures without known triggers at a gap of at least 24 hours are considered to be suffering from Epilepsy.
Epilepsy surgery is the most promising treatment that provides freedom from seizures in patients with the persistent seizures despite of requisite trials of at least 2-3 antiepileptic drugs.
The effectiveness of the surgery depends on the form of epilepsy, related pathology and appropriate identification of the seizure focal area with the help of neuroimaging and neurophysiological investigations. The modern advances in neuroimaging and EEG monitoring techniques have led to more accurate localization of the lesion and thus yields best results from epilepsy surgery in India.
The ultimate aim of the epilepsy surgery is to eliminate or reduce the episodes of seizures by analyzing and removing the abnormal part of the cerebral cortex causing seizures.
Epilepsy occurs as a consequence of permanent changes in the brain either due to some medical disorder or injury to the brain.
The most common known causes of epilepsy include:
- Traumatic brain injury
- Stroke or transient ischemic attack
- Loss of brain function, dementia
- Congenital brain disorder that is the brain disorders present from birth
- Brain tumours
- Cerebral infections including meningitis, encephalitis, brain abscess
- Abnormal blood vessels in the brain
- Metabolic disorders like phenylketonuria
- Bleeding or haemorrhage of the brain
The treatment options for epilepsy include:
Anti-convulsant or anti-epileptic drugs are the most common treatment for epilepsy. If one medication is not successful in controlling seizures, the doctors switch the drugs or adjust the dosage. About two- thirds of people with epilepsy become free of seizures with prescribed medication.
If your doctors can determine that your seizures always begin in a single area of the brain, removing that part of the brain can stop them or make seizures easier to manage. Surgery can also treat conditions that cause seizures, such as brain tumor.
The procedures included in this approach are:
- Temporal lobe resection surgery: This surgery is performed more commonly. In this the anterior and the middle portion of the temporal lobe, which is most often responsible for causing seizures is resected or removed.
- Functional Hemispherectomy: This is rare but most successful surgery which is performed in most of the widespread and fatal epilepsies. This surgery aims in removing almost entire half of the cortex (brain) to eliminate the seizures completely.
- Palliative: This approach is opts when there is no definite lesion identified. The aim of this procedure is to reduce the frequency and severity of the seizures by disrupting the nerve pathways that propagates the seizure.
Following procedures are performed in palliative treatment.
- Corpus callosotomy: It is surgical procedure performed to reduce the frequency and severity of mostly the generalized seizure or primary atonic (drop attacks) seizure by simply disrupting or cutting the fibers of the corpus callosum which serve a pathway for conduction of the seizure impulse between the two halves of the brain.
- Multiple subpial transections: This surgical procedure is indicated when the center of seizure is well localized but cannot be removed or resected as it is located in the vital area of the brain that is involved in speech production, memory and sensorimotor tasks. In such case, the surgeon cuts the nerve fibers in the outer layer of the brain and preserves the deeper fibres that control the vital neurologic function.
- Vagus nerve stimulation: It is a palliative procedure for the patient with partial or generalized seizures. During this procedure, the vagus nerve stimulator is implanted under the skin of the chest which electrically stimulates the vagus nerve periodically. These signals are then transmitted from the vagus nerve to part of brain expected to be involved in producing seizures resulting in subsequent decrease in frequency and severity of the seizures.
If you are having epilepsy seizures which are disabling and uncontrolled, despite of adequate trials of at least 2-3 antiepileptic medications, or if you are resistant to AED drug therapy and if the seizures are significantly affecting your life, then you can be considered for the epilepsy surgery.
The procedure is done under general anesthesia and it usually takes 3-4 hours to complete.
Once the anesthesia has taken effect and you are asleep, your head is fixed in a position and scalp will be prepared for the surgery. The surgeon then makes an incision on the scalp to expose the skull and a circular opening is drilled in the skull to expose the brain tissue.
Brain mapping is done using the intra-operative EEG monitoring and recording by stimulating the brain areas with the subdural electrodes. During mapping, the involved area is localized and with the help of operative microscope the surgeon resects and removes the area of the brain causing seizures.
All the structures are then sutured back and the bone flap is secured to skull with screws. Once this is done you are moved to Neuroscience Intensive Care Unit to monitor your vital signs.
You may experience headache and nausea after the surgery which can be controlled with medications. A stay of 3-4 days in the hospital is required after the surgery. Sutures are removed 7-10 days after the surgery. You can expect to return to the normal activities after 3-4 weeks. You may get fatigued very often which is common.
Walking is encouraged while driving and other strenuous activities should be avoided for few months. You are recommended to stay on AEDs for up to the year after the surgery, the dose of which can be gradually tapered and eventually stopped.
The results of the surgery are very gratifying. Following the definitive cure surgery, one can expect complete elimination of the seizure while the palliative treatment results in decrease in frequency and length of the seizures ultimately leading to near normal and healthy life.
We encourage you to educate yourself about epilepsy surgery in India, benefits from the right kind of procedure and then make an informed decision.
You can be rest assured that with Surgicure International's expertise. we bring in a wonderful experience of medical tourism in India, which we have been doing so for almost a decade now.