What Happens Before Surgery is Considered?
There will be a complete neurological evaluation, which will include detailed information of the seizures and drug treatments to date. Your doctor will want to know if there has been a reasonable trial period on conventional drug therapy and, he or she will carefully assess the side effects and medication compliance before you are referred to an epilepsy clinic.
Although most surgery patients are adults who have fought a long and unsuccessful battle for seizure control, many children with severe seizures are also being treated through surgery. Many childhood epilepsy syndromes can be effectively treated with the help of surgery. Even so, it is not a suitable treatment for everyone who has epilepsy, or for everyone with poor seizure control.
Criteria for surgery:
- failed to achieve adequate seizure control with reasonable trials of antiepileptic medication
- chance of benefiting from the surgery (the seizures have been disabling to the person’s quality of life)
The neurological evaluation will include:
- Patient medical history
- Referrals from your own physician
- Identification of the specific brain regions where the seizures originate
- Determine the safety level of the surgery and a strategy
- Estimate whether or not surgery will help to effectively control the seizures
The neurologists will use a variety of the surgical diagnostic techniques to determine the necessary information needed, including EEGs and MRI scans.
There are a few other tests that may be used before consideration of surgery by the medical professionals. Some of these tests are up for debate as to their relevance in evaluating a person for surgery. However, you may come across some of these procedures so the following is just a brief mention of the different types:
- Neuropsychological testing: this includes personality, memory, and language tests. While the effectiveness of this method of testing is debatable in terms of identification of epilepsy focus, it may help the doctors when discussing the post-surgery goals of the surgery candidate. This may be important for people who experience job related difficulty as a result of their uncontrollable seizures.
- Intracarotid amobarbital (Wada) test: used to determine which brain hemisphere contains the language functions. Once again, this test is debatable by doctors.
After surgery you will have regular EEGs to make sure that your seizures are being controlled properly. Surgery may help to reduce your overall number of seizures. In some cases it may completely stop the seizures, in others it may reduce the frequency of seizure-events.