Dr. Howard Goodkin: Hello, I'm Dr. Howard Goodkin for the International League Against Epilepsy. I will be speaking about how surgery can be used to treat epilepsy. Although for many people their seizures are well controlled by medication and they have a good quality of life. For some people the seizures prove impossible to control with medication. For these patients surgery may be an answer. Determining whether surgery will work is a complex process. The epilepsy team consisting of a Neurologist specializing in epilepsy, a Neurosurgeon, a Neuroradiologist, and a Neuropsychologist work together to find where the seizure start in the brain and decide if that area can be removed without doing harm to the patient. The team performs prolonged EEGs, often a week or longer, to see where the seizures began. They combine the EEGs seizure information with a number of different brain scans, as well as the neuropsychological results to locate the area where the seizures start. In some cases the EEG recordings have to be repeated using electrodes that the surgeon will put inside the head and place directly on the brain. Once the team decides where the seizures start, they will discuss with the patient, how likely it is that the surgery will control seizures and what the risk are for surgery. If surgery is an option, a surgeon will try to remove the part of the brain in which the seizures originate. The chance for success depends on what the cause of the epilepsy is and where the seizures are coming from. For some types of epilepsy, from some parts of the brain, there's an 80% chance that the seizures will come under control, but for other types, the chances are closer to 50%. Surgery is not a cure and people still may need to take some seizure medication, although the dosage may be lowered. Surgery cannot be used for all types of epilepsy and for some patients the exact starting point of the seizures cannot be found.
We're constantly looking for ways to improve surgery and make it more successful, because we are still learning about surgery, it is important that surgery be performed at a large comprehensive epilepsy centre that has assembled the necessary team, not only to increase the chances for success, but also to help improve surgery for future patients.