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Epilepsy surgery can drastically reduce or completely stop seizures caused by epilepsy and other neurological conditions. About 25 percent of children with epilepsy do not respond to medicines and may benefit from a surgical procedure to control their seizures. Surgery may also be an option for children with epilepsy who have side effects related to their required medicines or who require multiple medicines to regulate their seizures and still have frequent seizures.
While no parent imagines their child having brain surgery, epilepsy surgery is a very safe and effective management strategy for those who have uncontrolled seizures despite using medications or diet therapy. New minimally invasive techniques at Riley at IU Health use small incisions that are barely noticeable on the scalp.
Surgery is a good option for children who have medically refractory epilepsy, with seizure freedom rates in some conditions of 80-90%. Riley at IU Health offers a modern approach to epilepsy surgery, including resective, disconnective, neuromodulatory and ablative procedures.
This is the most common type of epilepsy surgery. Resective surgery means removing brain tissue causing seizures either from a lesion (lesionectomy), a lobe of the brain (temporal lobectomy), or a section of the brain (quadrantectomy). This form of surgery can result in no seizures in 70-80% of cases when tests identify a specific area in the brain that’s causing your child’s seizures. This means that there is a specific, localized group of abnormal brain cells that send abnormal signals and cause irregular brain activity at random. The exact spot or focus of seizure activity in the brain can be seen on an electroencephalogram (EEG) or a magnetic resonance imaging (MRI) scan. If the seizure focus can be safely removed, surgery may be the best treatment to stop your child’s seizures.
Children with generalized seizure disorders or focal onset seizures with rapid generalization may benefit from a palliative surgery called a corpus callosotomy. This surgery involves disconnecting the two hemispheres of the brain so they cannot allow seizure activity to cause falls and injuries. This procedure can also be done through minimally invasive surgery using lasers through very small incisions. In patients with atonic seizures the procedure decreases seizure frequency by 90%.
Other patients who have seizures coming from an entire hemisphere of the brain because of a previous stroke, malformation of cortical development or genetic or inflammatory condition might benefit from a Hemispherectomy or functional hemispherotomy. While these procedures may seem overwhelming to think about, they frequently stop seizures from occurring and have surprisingly few neurological deficits.
Your child may benefit from the placement of stimulation devices in the nervous system. There are many indications for neuromodulation, which includes vagus nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS).
This therapy is reserved for patients with frequent seizures resistant to medications that come from numerous seizure-causing areas on both sides of the brain. A vagus nerve simulation (VNS) uses a generator that is surgically implanted under the skin in the left chest and an electrode array (wire) that is wrapped around the left vagus nerve and connected to the generator. The stimulator controls seizure activity by sending electrical impulses to the brain from the vagus nerve in the neck. This therapy is the most common neuromodulatory procedure and frequently decreases seizure burden by 50% but does not commonly lead to cure.
This is a recently FDA approved treatment for the indication of epilepsy. Many centers are currently applying the deep brain stimulation (DBS) leads to nuclei in the thalamus to attempt to treat generalized epilepsy syndromes. Although new to the U.S., the technique has been performed in Europe and around the world since 2010.
An integrated device with a battery that is implanted in the skull and attached to two wires which are placed on or in the brain. The so-called “brain pacemaker”, this device is the only one of its kind which can sense seizures and then stimulate them to stop the seizure.
Epilepsy patients who have very small brain areas that cause seizures may benefit from minimally invasive focal destruction by laser technology. This is called laser interstitial thermal therapy (LITT) and is performed at Riley Hospital for Children at IU Health. This data is contributed prospectively to an international registry along with other large academic centers.
Some children don’t have enough evidence during our Phase I diagnosis for doctors to definitively perform one of the above procedures. In these patients, a Phase II surgery is often the next step in your child’s care plan. Phase II surgery involves the placement of electrodes on or in the brain. This is called subdural grids or strips, or stereoelectroencephalography (sEEG).
Subdural grids or strips are flat electrodes which are placed on the surface of the brain. It involves a sweeping scalp incision with bone removal from the skull (craniotomy) and then bone replacement. Your child is monitored with electrodes on the surface of the brain while in the Pediatric Intensive Care Unit (PICU) until a surgical plan is determined. Once this is determined, your child returns to the operating room for removal of the subdural grids and resection of the tissue causing seizures.
sEEG is a procedure where depth electrodes are implanted often on both sides of the brain (bilaterally) through small incisions. Your child is then woken up and these electrodes are monitored until a surgical plan can be determined, at which time he or she goes back to the operating room for removal of electrodes and either resection or ablation.
The robotic stereotactic assistant (ROSA) is a neurosurgical robot which assists the stereotactic placement of electrodes into a target with high accuracy. Riley at IU Health is the only facility in the state of Indiana that owns and operates the ROSA for highly accurate neurosurgical procedures.
If left untreated, frequent seizures can be physically and mentally debilitating and even fatal.
In most cases, children who have seizure surgery are free of seizures or have significantly fewer seizures and may no longer need medicines a year or two after the procedure.
Before your child is approved for seizure surgery at Riley at IU Health, he or she will complete a full medical workup with the pediatric neurology and neurosurgery teams. Children who are candidates for epilepsy surgery typically experience seizures daily or more than once a day, despite being on two or more medicines.
After all pre-surgical testing is performed, a multidisciplinary group of neurologists, neurosurgeons and neuropsychologists will meet to discuss whether your child is a good surgical candidate. The team then presents the surgical options to your family and explains the chosen procedure.
You can expect the following during the medical workup with our Epilepsy Program to determine if your child is a good candidate for seizure surgery:
You can expect the following on the day of seizure surgery:
Riley at IU Health has created a surgery preparation video to help you and your child know what to expect the day of their surgery. Visit our preparing for surgery page to learn more.
You can expect the following after seizure surgery:
Your child should return to normal activities soon after recovering from the procedure.
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.
Riley neurosurgeon Jeffrey Raskin performs a delicate operation to disconnect part of a 10-year-old’s brain to limit severe seizures. Similar to disconnecting the wires of a ticking time bomb, “it’s as aggressive as any epilepsy surgery gets, and we’re doing it here.”Continue reading