When considering surgical management of epilepsy many strong and automatic feelings, mostly anxiety producing thoughts, arise in patients and family members. This is appropriate considering that many Neurosurgery treatments we usually hear about are for very severe, life threatening illnesses, or associated with diseases such as malignant brain tumors where the patient's life expectancy is sadly limited, even with surgery. So, the typical feeling of most people when they hear 'neurosurgery' is negative.
Epilepsy, on the other hand, is a different problem than most brain diagnosis. Though neurosurgery can be offered for refractory epilepsy it is not associated with the usual risky and adverse consequences associated with the other common neurosurgical problems, like malignant brain tumors or severe brain trauma.
In fact, the risk and adverse effects of the recurrent uncontrolled seizures is always worse for those who are offered surgery than the actual risk of the surgery. This consideration is the most important issue considered by the multidisciplinary team when they consider any person for epilepsy surgery.
The human body is remarkable in its ability to take care of itself, to heal from injury, to fight disease, and to adjust to many adverse environmental and physiological states, and to learn and adapt. The brain is very capable of learning. It can be considered a learning machine. Just as we can learn to perform a physical activity well, like training to improve your golf swing, drive a car, or to memorize a new telephone number, it can also learn to be better at something that is undesirable like being able to manifest a seizure easier.
One way to learn is through repetition, that is, doing something over and over again. By practicing something we get better at performing it. Unfortunately, experiencing a seizure over and over again strengthens the epilepsy network and may even enlarge it, so that over time, seizures can tend to occur more readily and become stronger.
The brain's ability to reorganize and learn, possibly making uncontrolled seizures worse, is also the reason that allows for a possible surgical solution to the epilepsy problem. Since the original functional qualities of the aberrant epileptic network can be relearned elsewhere in the brain, often the epileptic network can be removed and no brain dysfunction occurs, since the function has re-developed outside of the epilepsy network.
If the epilepsy occurs early in life, before natural development of the brain slows down, entire brain processes, such as language and speech can re-develop in very distant regions from where it would have developed otherwise. This remarkable plasticity allows surgical resection of an abnormal region that would otherwise not be possible otherwise. That is, if the etiology of the seizures was present from early childhood, the usual brain functions in and near the area of the seizure onset region would probably have developed elsewhere, so they would not be at risk if the seizure network were to be removed. This is a fundamental reason epilepsy surgery is possible.
Modern brain imaging and non-invasive neurophysiologic analysis of normal and abnormal brain function have allowed an understanding of a person's epilepsy never before possible. Specifically, the epilepsy network can often be defined in relation to the normal functional networks, so a precise safe resection can be designed to safely alter the epilepsy network and completely control the otherwise medically uncontrolled seizures.
Neurosurgery has evolved and benefited from advanced technology and a growing understanding of complex brain function, making surgery of the brain safer than ever before. By considering and comparing the risks of recurrent seizures and the usual progression of epilepsy over the patient's lifetime to the risks of epilepsy surgery, epilepsy surgery, which can completely control seizures, is in the long run less risky than uncontrolled seizures.
Epilepsy surgery has an excellent chance of completely controlling seizures so it is warranted as a rational alternative. The absolute risk of surgery is less than that of uncontrolled epilepsy. However, the decision to pursue surgery to manage epilepsy is a complex one, requiring individualized and detailed analysis of the patient's work up data with discussion of specific details as they relate to that patient.
This is accomplished by the collective consideration of individual cases by the specialized members of the Comprehensive Epilepsy Center.
