What are the risk factors for epilepsy?
The key risk factors that are associated with epilepsy include age (seizures are common in the very young and the well-aged), a diagnosis of seizures in the family, and the association of certain conditions such as Cortical Dysplasia, Stroke, Tumors, Sturge-Weber Syndrome and Tuberous Sclerosis Complex.
What are the different types of seizures?
Although there are many different types of seizures, they can be grouped into 2 main categories: Focal vs. generalized seizures. Focal seizures are due to abnormal activity in just one part of the brain while generalized seizures are due to abnormal activities originating from both sides of the brain. Focal seizures can also secondarily generalize meaning that although the seizures started from one part of the brain, it can later spread to involve both sides of the brain.
What are the common causes of epilepsy?
The main causes of epilepsy including genetics, structural brain abnormalities, problems with metabolism, immune system abnormalities, brain infections and there are other unknown causes as well.
When is the optimal time to be evaluated for surgery?
If a child continues to have seizures despite being treated on 2 appropriately selected anti-seizure medications, further medication therapy only has a marginal chance at curing the seizures. It is thus very important to be evaluated for surgery given the serious side effects associated with uncontrolled epilepsy.
What tests may be performed to determine candidacy for epilepsy surgery?
Although each center may have a different protocol in evaluating children for epilepsy surgery, our work-up typically includes a complete seizure history, comprehensive neurological examination, video-electroencephalogram, a high resolution magnetic resonance imaging (MRI), Positron Emission Tomography (PET) scan and a neuropsychological evaluation. In certain instances, we may also choose one or more of the following tests including a functional MRI, magnetoencephalogram (MEG), single-photon emission computed tomography (SPECT), WADA test and a psychiatric evaluation.
Who is a good candidate for epilepsy surgery?
Patients with seizures that are not responding to medications who have a clearly identifiable area of the brain from which the seizures originate, and there are no side-effects of removing that region of the brain are the best candidates for epilepsy surgery.
How effective is surgery at curing seizures?
Although the specific success rate is completely dependent on the specifics of the epilepsy and is highly individualized, typically 50 to 80% of patients that are deemed to be a candidate for epilepsy surgery can be cured. The majority of the remaining patients experience a large reduction in the number of seizures although they may have occasional seizures. Very few patients experience no improvement with epilepsy surgery. Following seizure control, other neurocognitive functions commonly improve such as attention, concentration, behavior and social interactions.
The typical high success rates of surgery when compared to all non-surgical forms of treatment for patients who continue to have persistent seizures make this is a very desired treatment strategy. For some patients, anti-seizure medications may be reduced or discontinued by a neurologist in a year following the operation. Other patients may require continued medical therapy in order to remain seizure-free.
Is epilepsy surgery safe?
At experienced centers, surgery has low complication rates of about 3-5% and almost no reported cases of mortality. Epilepsy surgery has also been around for well over 100 years.
