Surgical treatment of epilepsy

Epilepsy is a chronic disease of the human brain, which has a different etiology and is characterized mainly by repeated seizures and the gradual development of personality changes. This is one of the most common neuropsychiatric diseases: in the general population, there are 7-10 cases per 1000 population. Regular use of anticonvulsant medications leads to the prevention of further seizures in about 70% of patients. The choice of drug depends on the type of seizures, the age of the patient, and possible side effects. Over the past decades, scientists have developed second-generation products that are better tolerated. However, these medications do not help all patients. With the ineffectiveness of drug treatment or a severe course of the disease, doctors still have a neurosurgical operation.

Patients with a focal focus of epilepsy can really be helped by an operative method. In the process of complex preoperative diagnostics, the location of the epileptogenic zone is determined. Surgical treatment is an operation that removes the area of ​​the brain that causes epileptic seizures. In this case, accurate localization of the focus responsible for the development of seizures is necessary. It is also important to establish that the removal of a certain part of the brain will not lead to unexpected consequences, for example, loss of speech or severe movement disorders. For every patient candidate for epilepsy surgery, a basic 30-minute EEG recording is required, as well as an EEG recording during waking and sleeping. However, monitoring can continue for several days until a final diagnosis is made. If there are indications for surgery in children, surgical treatment should be started as early as possible, since there is evidence that surgery at an earlier age gives better results. Depending on the type and location of the epileptogenic focus, its removal leads to the disappearance of seizures in 40-80% of patients, that is, the chances of a complete cure from seizures are quite high.

Callosotomy is a separate type of surgery used in the treatment of epilepsy and consists in dissecting the corpus callosum (the structure responsible for the “connection” of the right and left hemispheres of the brain). This procedure is indicated for patients with generalized seizures and bilateral independent epileptic foci in the frontal lobes of the brain, as well as for patients with frequent seizures of epilepsy, such as a “drop attack”. These are short attacks in which the patient loses muscle tone and falls to the floor. In this case, injuries often occur. The operation of callosotomy prevents the rapid spread of convulsive activity from one half of the brain to the other.  

Severe neurological disorders after such operations develop relatively rarely, although patients have some impairment of intellectual functions and, for example, difficulty in identifying body parts. Problems with memory and the emotional sphere are not common.

According to some reports, the surgical treatment of epilepsy is not a discovery of recent centuries. It is believed that trepanation as a method of treating mental ailments, including epilepsy, was used in ancient Greece and Rome. Then it was believed that in this way (through the hole in the skull) it is possible to “release demons” causing mental illness.