Surgical Treatments
About Treatments
Anti-epileptic drug therapy is effective in approximately two-thirds of people with epilepsy. The rest do not obtain good seizure control or have unacceptable side effects of the medications. The concept of good seizure control is somewhat elusive. How long must a patient go without a seizure before control is considered good? This is a matter of individual differences of opinion.
In many states, an individual cannot obtain a driver's license if he or she has had a seizure within one year. Good control might therefore represent being seizure free for one year. The standard is often set too low, with physicians who believe that a seizure every few months is not "too bad." Such a seizure can have a major impact on the quality of life of people with epilepsy.
Part of the challenge of epilepsy specialists and pharmaceutical companies is to encourage treating physicians and patients to strive for better control of their seizures, and not just to accept the limitations imposed by occasional seizures.
Surgery Options
Some people who cannot be controlled with medications are candidates for surgery to cure their epilepsy. Counts of potentially eligible candidates range in the 20,000 - 50,000 range in the United States. Since only a few thousand operations are done each year, it is apparent that surgery for epilepsy is under-utilized.
The key to epilepsy surgery is localization of the seizure focus. Typically, seizures that can be cured with surgery will arise from one of the inner portions of the temporal lobe, either left or right.
Wada (intracarotid amobarbital) Test
The Wada (intracarotid amobarbital) test is done to localize speech and memory functions in some candidates for epilepsy surgery.
Temporal Lobectomy Surgical Prodedure
During a Temporal Lobectomy Surgical Prodedure, the patient is positioned and asleep, the surgery begins. A patch of hair over the temple is shaved, but it is not necessary to shave the entire head.
Skin is cut in a "C"-shaped partial circle above the ear. Several nickel-sized holes are drilled in a circular pattern. A bone-saw cuts between the holes to remove a circle of bone about the circumference of a small coffee cup rim.
At the end of the procedure, this bone will be hard-wired back in place and eventually will calcify to seal to the skull. The wires are non-magnetic (MRI compatible), hold the bone firmly in place, and never need to be removed.
Other specialized procedures are performed less often than is partial temporal lobectomy.