Appropriate candidates for surgery are those who have seizures that:
The patientís perception of the severity of his or her epilepsy is a key determinant. The patient, the neurologist, and the neurosurgeon should join in deciding whether to proceed with surgery.
In general, the success rate is high, especially when the epileptogenic region is a discrete area of the brain, such as within the anterior temporal lobe, and the incidence of complications with most procedures is low. The decision always involves a balance between potential risk and benefit. Typically, patients who are being considered for epilepsy surgery are evaluated at comprehensive epilepsy centers, which have experience in weighing all of these factors.
Neither the process of evaluation nor the experience of undergoing surgery are easy for patients or their families, but the low risk and favorable outcome statistics make surgery an option worth weighing by patients who have seizures that are not controlled by medication. If antiepileptic drug (AED) therapy proves unsuccessful, it may be time for the person to be evaluated for possible surgery.
Objective measures of seizure frequency and severity are not the only factors determining whether a particular person with epilepsy will choose to be evaluated for surgery and will handle the process well. Factors like age, present and previous lifestyle, priorities, family reactions, and other social supports are all important. Counseling, often including family members, is commonly encouraged both before and after epilepsy surgery.
Quality of life has become a key factor to consider when making the decision about epilepsy surgery. An obvious goal is seizure freedom. If seizure freedom is not possible, however, then even simplifying the medication regimen or reducing overall seizure burden are acceptable outcomes. Each personís situation is considered individually and the treatment goals are determined for that individual.
Reviewed and revised January 2004 by Howard Weiner, MD, New York University.
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