What is Epilepsy Surgery?

One of the treatments for epilepsy, commonly known as 'seizures' among the public, is epilepsy surgery. While medications can provide a response in most epilepsy patients, there are also patients who require surgical procedures.

What is Epilepsy?

The human brain is regularly stimulated by electrical signals, which spread throughout the body. Epilepsy is characterized by abnormal electrical signals occurring in certain areas of the brain. These signals result in various symptoms as they incorrectly stimulate nerve cells throughout the body. These symptoms can affect individuals of all ages, occurring solely in children or persisting throughout life. When symptoms resembling epilepsy seizures are observed in infants, it is important to seek medical attention promptly. Treatment options for epilepsy in infants include medication.

What is an Epileptic Seizure?

Seizures are symptoms of epilepsy. Bursts of abnormal electrical activity in the brain cause seizures. Seizures can last from a few seconds to several minutes. Also known as an epileptic fit, seizures can lead to symptoms such as loss of consciousness, fainting, and sudden unusual movements. There are many different types of seizures, and when they occur for the first time or are severe, seeking medical attention is necessary. When a person with epilepsy is admitted to the hospital, all conditions related to seizures are indicated by the code G40. This allows for identification of whether the person is diagnosed with epilepsy or not.

What are the Types of Epileptic Seizures?

The types of epileptic seizures vary depending on where in the brain they originate. Some seizures involve loss of consciousness and uncontrolled body movements, while others may have milder symptoms. Seizures lasting between 30 seconds and 2 minutes require immediate medical attention if they last longer than 5 minutes. Some epileptic seizures may also present as drowsiness, sluggish behavior, unusual tastes and smells, distorted sense of time and space, reduced speech, and very slow movements.

Simple Partial Seizure

In simple partial seizures, consciousness remains intact. The symptoms of the seizure vary depending on the brain region where the seizure originates:

• Seizures originating from the temporal lobe manifest as sudden fear, feeling as if an event that has never occurred before is happening, or as if an event that has occurred has not happened, smelling unpleasant odors and tasting unpleasant tastes, and an inward unpleasant sensation.
• Seizures originating from the frontal lobe involve problems related to movement.
• Seizures originating from the parietal lobe present temporary numbness symptoms, while seizures originating from the occipital lobe manifest as flashes of light and different colors affecting half of the visual field.

Complex Partial Seizure

In addition to simple partial seizures, there is also impairment of consciousness in complex partial seizures. There may be chewing, licking, swallowing, and a bewildered staring as if searching for something. Sometimes, the patient may tug at their clothes and wander around. Minutes or even hours later, when they come to, they may not remember anything.

Generalized Seizure

Generalized seizures, which spread throughout the entire brain, are also known as grand mal seizures in colloquial terms. After the person becomes rigid and falls to the ground, there are muscle contractions and relaxations in all body muscles. Severe movements occur beyond the person's control. In addition, in some generalized seizures known as absence or "petit mal," although there may be no movement or contraction in the body, the person loses consciousness.

What is Epilepsy Surgery?

Epilepsy surgery procedures can help reduce the number or severity of certain types of seizures. Epilepsy surgery may involve cutting out or removing the region in the brain causing seizures. Before epilepsy surgery, imaging tests should be performed to examine the function of the targeted area in the brain. Not only removing this part, but some surgically implanted devices can also be used to treat epilepsy. These devices provide internal electrical stimulation that helps regulate the electrical activity in the brain to prevent seizures. Surgical resection, surgical disconnection, stereotactic radiosurgery, laser interstitial thermal therapy, and nerve stimulation devices are methods used in epilepsy surgery.

How is Epilepsy Surgery Performed?

The manner in which epilepsy surgery treatment is applied varies depending on the selected procedure. The procedures include:

• Surgical resection: This surgery involves removing areas in the brain that generate abnormal electrical signals. It is preferred when seizures become severe, risky, and uncontrollable.
• Surgical disconnection: The connection between the part of the brain causing seizures and the normal brain areas is severed. This option may be considered when resection is not possible for individuals experiencing severe seizures.
• Stereotactic radiosurgery: Using radiation beams, nerve cells causing seizures are destroyed. Imaging techniques are used during the procedures.
• Laser interstitial thermal therapy: This surgery is less invasive compared to other options. A laser directed to the problematic area in the brain through a hole in the skull destroys nerve cells.
• Vagus nerve stimulation: A pulse-generating device is placed under the collarbone, and its electrical wires are wrapped around the vagus nerve in the neck. This device blocks the signals causing seizures when they occur and can prevent the onset of seizures.

How Does Epilepsy Occur?

Epilepsy is a sensitive mixture of brain neurotransmitters, nerve cells' electrical excitations, and chemicals. Depending on which part of the brain is affected, there are different types of seizures. Cells communicate with each other in the brain using chemical messengers released as a result of electrical signals. When these signals are excessively strong and abnormal, a person may lose consciousness and experience convulsions.

What Causes Epilepsy?

In some cases of epilepsy, no specific cause is found. If an identifiable cause exists, it is a condition affecting the brain. Any damage has the potential to disrupt the brain's function and cause seizures. Factors that can cause epilepsy include:

• Genetics
• Head trauma
• Brain tumor
• Infections such as meningitis
• Developmental disorders

What Are the Symptoms of Epilepsy?

Epilepsy arises from abnormal electrical discharges in the brain. Epilepsy can manifest with limited symptoms, but sometimes seizures spread rapidly, leading to serious symptoms. Symptoms vary depending on which part of the brain epilepsy affects. Symptoms of epilepsy include:

• Blank stares
• Muscle stiffness
• Involuntary muscle movements
• Loss of control over limbs and twitching
• Loss of consciousness

What Are the Risks of Epilepsy?

Epilepsy (seizure disorder) can lead to harm during seizures. During a seizure, a person may fall, hit something, or choke. Individuals whose seizures are not under control may not be allowed to drive. When seizures occur, a person loses control, and the involuntary movements that occur in an unsafe environment can cause physical harm. Additionally, there is a risk of biting the tongue or other injuries because of the loss of control during seizures. In some epilepsy patients, prolonged seizures called Status epilepticus may occur, lasting longer than 5 minutes and the person may not regain consciousness. This is a medical emergency that requires prompt treatment.

Types of Epilepsy

The types of epilepsy vary depending on the type of seizure experienced. These types include:

• Generalized seizure: Also known as a grand mal seizure, this type affects the entire body. It begins with a sudden loss of consciousness. Following the loss of consciousness, there is body stiffening followed by involuntary movements of the muscles. Tongue biting and loss of bladder control are common during these seizures. When the person regains consciousness, they may experience confusion, drowsiness, memory loss, headache, and agitation.
• Generalized seizure types are further categorized into: Absence: Absence epilepsy, usually seen in children, can cause mild muscle twitches. In addition to these twitches, the person may have a blank stare. Also known as petit mal epilepsy. Petit mal epilepsy refers to sudden onset epilepsy seizures in children, also known as absence seizures. Most people can be cured with medication before adulthood.
• Tonic: Causes stiffening of the muscles, especially in the back, legs, and arms.
• Clonic: Leads to involuntary contractions and relaxations of various muscles on both sides of the body.
• Myoclonic: Causes muscle contractions in the upper part of the body, arms, or legs.
• Atonic: The person experiencing the seizure may fall involuntarily due to loss of muscle tone.
• Tonic-clonic: Involves the body becoming stiff and muscle jerking.
• Focal seizure: Focal seizures occur partially in the body. Abnormal electrical signals begin in a specific area of the brain, affecting body parts controlled by the affected area of the brain. Seizures can involve unusual movements, emotions, feelings, or behaviors. People may have different levels of consciousness during focal seizures.

How is Epilepsy Diagnosed?

During a doctor's examination, various imaging techniques are employed when epilepsy is suspected. Based on the results of tests such as electroencephalogram (EEG), computed tomography (CT), and magnetic resonance imaging (MRI), a doctor can diagnose epilepsy. Electroencephalogram measures electrical activity in the brain to help identify abnormal electrical signals. EEG not only confirms epilepsy but also helps determine whether epileptic seizures originate from a small part of the brain or the entire brain.

What Are the Treatment Methods for Epilepsy?

Epilepsy can be treated with antiepileptic medications, dietary therapy, and surgery. Medications are used to reduce the tendency of brain cells to send excessive and abnormal electrical signals, thus preventing seizures. Dietary therapy is implemented with a ketogenic diet. The ketogenic diet ensures that fat becomes the body's primary energy source during daily nutrition. This can lead to a reduction in seizure occurrences. However, some patients may be resistant to ketogenic diets and drug therapies. "What is drug-resistant epilepsy?" Drug-resistant epilepsy does not respond to drug treatments. Additionally, dietary interventions may not be effective in alleviating symptoms. In such cases, epilepsy surgery is a preferred option. However, not all patients with drug-resistant epilepsy may be suitable candidates for surgery. The suitability of patients for surgery is determined through detailed tests.

Who Gets Epilepsy?

Many people with epilepsy may experience seizures without any obvious triggers. Sometimes epilepsy can be due to genetic predisposition. Individuals who have experienced seizures in early childhood are more likely to have a genetic predisposition to epilepsy. Conditions that can trigger seizures in people with epilepsy include:

• Stress
• Lack of sleep
• Excessive alcohol consumption
• Certain medications
• Flashing lights

Epilepsy: What to Do When Someone Has a Seizure

During a seizure, the person loses consciousness and cannot control their movements, which may pose a risk of self-harm. If someone with epilepsy is having a seizure, here's what to do:

1. Keep the person safe and secure.
2. Remove or loosen any tight items around the neck, such as a necklace or tie.
3. Measure the duration of the seizure.
4. If the person is unknown or having their first seizure, call for an ambulance.

Frequently Asked Questions:

Can epilepsy be detected on a brain MRI?

Epilepsy may not be diagnosed solely through a brain MRI, but it can assist in the diagnosis and reveal conditions in the brain that could cause epilepsy.

Can epilepsy be caused by stress?

Stress alone does not trigger epilepsy, but it may lead to seizures in individuals who already have epilepsy.

Does epilepsy affect intelligence?

Epilepsy is not a disease that affects intelligence, but a person may lose consciousness during seizures.

What should the diet of epilepsy patients be like?

The ketogenic diet has been used for epilepsy for many years, but it may not be suitable for every patient. If deemed necessary by a doctor, patients can be referred to a dietitian to start a ketogenic diet.

Who is eligible for epilepsy surgery?

Epilepsy surgery is performed on individuals who do not respond to diet and drug therapy. Additionally, if seizures persist despite treatment and cause severe symptoms, surgery may be recommended.