Decoding Epilepsy, Part II: Mapping the Brain's Mysteries
Surgery for Seizures
Expert Q&A with Richard Restak, M.D.
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Q: When is surgery a good option for a person with epilepsy? Does it depend on the severity of the seizures?
—— Janel, Pennsylvania
A:Surgery becomes an option when a trial of at least two anticonvulsant drugs isn't effective in controlling seizures. Quality of life issues also play a role in determining whether surgery makes sense for a specific person. Among other factors, you and your doctor would need to consider how much of an impact seizures are having on your ability to work and maintain mutually satisfying interpersonal relationships.
The nature of the seizures and the localization of the seizure focus also play a great role in any decision about epilepsy surgery. In general, patients with seizures originating in the brain temporal lobe are the best candidates. While temporal lobe seizures are among the hardest to control with medication, they typically respond very well to surgery. Like all surgery on the brain, epilepsy surgery carries risks that vary according to the procedure, the localization of the seizure focus, and the skill and experience of the neurosurgeon. Even under the best of circumstances, patients still may require anticonvulsant medication, but it's usually at a lower dose and with fewer side effects.
Richard M. Restak, MD, is clinical professor of neurology at George Washington Hospital University School of Medicine and Health Sciences.
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