Surgery for Epilepsy & Seizure Disorders in Adults
Medication keeps seizures under control for many people with epilepsy. However, when symptoms in adults aren’t managed well with medication, surgery can be a very effective treatment option. Specialists at NYU Langone’s Comprehensive Epilepsy Center offer several types of surgery to control seizures.
The Comprehensive Epilepsy Center is one of the largest treatment centers in the United States for adults and children. During the past 6 years, NYU Langone surgeons have performed more than 300 brain surgeries for adults with epilepsy.
Due to our tremendous success in treating people who were not considered surgical candidates by other centers, the Comprehensive Epilepsy Center has earned an international reputation for treating people with the most challenging conditions. It has also established an exceptional record of safety.
The goal of epilepsy surgery is to neutralize or remove any parts of the brain that aren’t working correctly, without injuring healthy brain tissue or impairing neurological function. To accomplish this, NYU Langone epilepsy specialists first identify the areas of the brain that are problematic. This process is known as a preoperative workup.
During a preoperative workup, the doctor performs tests to define epileptic and healthy brain areas and determine if a person is a good surgical candidate. The tests used depend upon symptoms but always include brain imaging scans, tests of language and memory, and video electroencephalography, which is performed in the hospital to record seizures as they occur.
Epilepsy surgery may consist of a single procedure in which seizure-causing brain tissue is removed, or it may require two surgeries. If two procedures are needed, the doctors first implant electrodes for monitoring and recording seizure activity. During another surgical procedure about one week later, the doctors remove the brain tissue that monitoring has revealed to be problematic.
Epilepsy surgeries are performed in the hospital with general anesthesia. People typically stay in the hospital for about 4 to 10 days, depending on which type of surgery is performed.
At NYU Langone, epilepsy surgery is much less invasive than it was 20 years ago. Little hair is removed, and surgery is performed with greater accuracy due to advancements in neurosurgical technology.
At NYU Langone, approximately 90 percent of the best candidates for surgery have complete seizure control after surgery. And in at least half of people who have more complex types of epilepsy, seizures stop after surgery. In total, about 65 percent of those who have had epilepsy surgery at NYU Langone become free of seizures.
Types of epilepsy surgery include the following.
Temporal Lobe Resection
The most common surgical procedure for epilepsy is the removal of a small portion of the temporal lobe during a procedure called a temporal lobe resection. More than 70 percent of people who have this surgery at NYU Langone become seizure-free or enjoy a marked improvement in seizure control.
Most people need less antiepileptic medication after surgery, and about 25 percent of people who are seizure-free can eventually discontinue medication.
Resection of Frontal, Parietal, or Occipital Areas of the Brain
Typically, removal of tissue in the frontal, parietal, or occipital area of the brain is performed when a structural abnormality is identified on MRI scan. These procedures often lead to excellent surgical outcomes.
In a corpus callosotomy, the connection between the right and left sides, or hemispheres, of the brain is cut. This slows down the electrical activity between the two halves of the brain that can lead to a seizure.
Although this procedure doesn’t prevent seizures from occurring altogether, it decreases their frequency and severity.
Surgeons perform this technique in people who have sudden “drop” seizures, including the tonic and atonic seizures experienced by people with Lennox–Gastaut syndrome, a rare but severe epilepsy syndrome associated with intellectual disability and multiple seizure types, including drop seizures, that are difficult to control. These seizures can cause falls and injuries.
During a partial callosotomy, about 20 percent of the back part of the corpus callosum—the thick band of nerve fibers that separates the two hemispheres of the brain—is left intact.
Research has shown that corpus callosotomy helps reduce the severity of drop seizures. After a partial callosotomy, seizure frequency is reduced by an average of 70 to 80 percent. A complete callosotomy reduces the frequency by 80 to 90 percent.
If doctors find that a person’s recurrent seizures are caused by a specific abnormality in the structure of the brain, also called a lesion, they may perform a procedure called a lesionectomy to remove it. For many people, the procedure results in complete seizure control.
Hemispherectomy and Hemispherotomy
A hemispherectomy and hemispherotomy procedure involves combinations of removing and disconnecting one side of the brain from the rest of the brain. This procedure is only considered for people who have severe epilepsy and seizures that arise from only one side of the brain, leading to poor function in that hemisphere.
The side of the brain that is to be disconnected functions very poorly and often impairs the functioning of the other side of the brain. More than 75 percent of people who have a hemispherectomy or hemispherotomy experience complete or nearly complete seizure control.
Multiple Subpial Transection
Multiple subpial transection is a procedure used to control focal seizures that originate in areas of the brain that can’t be removed safely. In this procedure, the surgeon makes a series of shallow cuts, called transections, in the outer rim of the brain, the cerebral cortex.
These cuts interrupt some nerve fibers that connect neighboring parts of the brain and promote seizure spread. These transections don’t appear to cause long-lasting impairment in critical brain functions in these areas.
Multiple subpial transections can help to reduce or eliminate seizures arising in vital, functional areas of the brain.
Recovering from Surgery
Most people are able to get out of bed the day after epilepsy surgery. They usually return home about two to five days after the procedure. Most people return to work about four to six weeks afterward.
By the time they go home from the hospital, most people are able to dress, feed, and wash themselves. However, they may feel tired and need a nap during the day, and their sleep–wake cycles may be altered.
Most people need only over-the-counter pain relievers after leaving the hospital, but sometimes the doctor prescribes a mild prescription pain medication.
Staples used to close incisions in the scalp are removed 7 to 14 days after surgery, depending on the type of procedure performed. During a follow-up visit, the doctor removes the staples during a simple procedure. You can shower and wash your hair five days after the surgery, even if the staples have not yet been removed.