About a quarter of people with epilepsy have refractory seizures, meaning that they continue to have seizures despite optimal treatment with antiepileptic medication. In these patients, other treatments may be warranted. Such treatments include surgery that removes the irritated piece of brain that sparks the abnormal electrical activity that then spreads over the rest of the brain's surface like a wildfire during a seizure.
The temporal lobe is a common source of seizures. In mesial temporal sclerosis, the temporal lobe is abnormally shriveled in appearance. Electrical recordings over the area may show spikes of activity that indicate the region is capable and ready to fire off further seizures.
A recent study from the British medical journal The Lancet followed 615 patients following surgeries that removed the cause of their seizures. After these surgeries, 52 percent had no seizures over a five year period following the surgery, and 47 percent remained seizure-free after a decade.
Being seizure free can mean a very different lifestyle to people with longstanding epilepsy. It can mean they regain their ability to drive, to work and play without fear of suddenly losing consciousness. Despite the successes of surgery in refractory epilepsy, many do not opt for this procedure.
Perhaps it is the daunting idea of having brain surgery that puts people off. Very detailed testing is done at epilepsy centers prior to any surgery to ensure that a surgery would not remove any essential brain tissue, and would therefore have little or no effect on the person's ability to go about life as usual. Still, for many the very idea of such a surgery is off-putting. Others may not have access to the specialists who do this kind of testing.
Others may simply not know about the potential benefits of surgery, and thereby submit themselves to more medication trials, although the probability of any medication working after two or three have failed to control seizures is less than a few percentages.
These surgeries are expensive, usually costing tens of thousands of dollars. Given the costs of a lifetime of medications, doctors appointments, and diminished ability to work, however, the costs of an operation start making more sense in the long-term.
It is critical that patients know about the availability, risks and benefits of all available treatments for their medical condition. To learn more about treatment of epilepsy, read the following: Treatment of Epilepsy and Seizures.