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Goal of the Cure — definitive procedures that entail the removal of epileptogenic tissue. The goal of most resections is complete elimination of seizures.
Goal of Palliation — procedures that interrupt nerve pathways involved in seizure production and propagation. The goal of palliation is a decrease in seizure frequency and severity.
Goal of Cure
Lesionectomy — Many patients with recurrent seizures have been found to have small lesions that clearly cause the seizures. Lesionectomy usually has excellent results.
Temporal lobe surgery — The majority of surgeries involve the temporal lobe. In a study of our patients, 73 percent were seizure free after temporal surgery, and 96 percent were either seizure free or significantly improved. There was no neurological morbidity or mortality. (Bowling et al. West Virginia State Medical Journal 2007)
Extra-temporal lobe surgery — Surgery for extra-temporal lobe epilepsy is less common than temporal lobe. If no definite lesion is identified, the success rates may not be quite as high. Despite this, the opportunity for seizure freedom from surgery far exceeds the chance of stopping seizures with medicine alone.
Hemispherectomy — This procedure is most commonly performed in children with severe and widespread epilepsies. Typically, the surgery is anatomically subtotal but functionally complete. Functional hemispherectomy is one of the most successful surgical procedures for treating widespread and catastrophic epilepsy, with the majority of patients able to realize seizure freedom.
Goal of Palliation
Corpus callosotomy — Sectioning of the corpus callosum may be beneficial for partial seizures that secondarily generalize. In addition, uncontrolled generalized seizures, especially “drop attacks,” have an excellent opportunity to be eliminated with this surgery. Anterior 2/3 callosotomy is usually sufficient to stop drop attacks and the most violent generalized convulsions.
Multiple subpial transections — While the most effective treatment of partial seizures has been removal of the seizure focus, this is contraindicated when the region performs an indispensable function such as speech or sensorimotor function. MST preserves intrinsic cortical function while treating epileptogenesis. The surgeon makes parallel cuts through the cortex to permanently disrupt cortico-cortical neural networks that may be propagating seizure activity.
Vagus Nerve Stimulation — VNS can be used for patients with partial or generalized seizures with no opportunity for a curative surgery. The vagus nerve stimulator is implanted under the skin of the chest. A wire from the device tunnels under the skin and is attached to the vagus nerve in the left side of the neck. The device electrically stimulates the vagus nerve periodically at a rate that is adjustable. The surgery usually requires no overnight stay. With VNS, approximately half of patients can expect a 50 percent or greater reduction in seizure frequency.
