If medication didn’t work, epilepsy surgery can provide hope for patients.

Story by: Sara Thompson on July 20, 2022

If medication fails in controlling epilepsy, there is still hope. Medication failure means that two different medicines have not controlled your epilepsy. Surgery for epilepsy is an alternative means of stopping seizures or reducing seizure severity.

Should I have surgery for epilepsy?

“Medication-resistant epilepsy” (known medically as refractory epilepsy) is a condition where seizures do not stop with medicine. Uncontrolled seizures can result in health risks, including physical harm — think drowning — during a seizure; sudden unexpected death in epilepsy (SUDEP); depression and anxiety; or worsening memory and thinking skills.

Your doctors will run tests to see if you are a candidate for epilepsy surgery. Tests include electroencephalogram (EEG), MRI, and brain-mapping tests like functional MRI and a Wada test. Epilepsy neurologists with Norton Neuroscience Institute (Ambica M. Tumkur, M.D.; Rebekah J. Woods, D.O.) then collaborate with epilepsy neurosurgeons (Abigail J. Rao, M.D.; David A. Sun, M.D., Ph.D.). 

“We find surgery is highly effective if the seizures originate in one place in the brain,” Dr. Rao said.

Types of surgery for epilepsy

Norton Neuroscience Institute neurosurgeons use ROSA, a robotic-assisted surgery tool, to map the safest route through the brain to identify the source of epilepsy disorders. The ROSA system generates a 3D map of your brain, so surgeons can see structures at any angle and any depth. With the imaging in hand, surgeons use ROSA’s robotic arm to thread tiny tools through holes the width of spaghetti noodles, to the source of your seizures. This surgery, through small incisions, avoids removing part of the skull.

Other epilepsy surgeries include:

• Resective surgery: The surgeon removes the portion of the brain where seizures originate. This can be the site of a tumor, brain injury or malformation.
• Laser interstitial thermal therapy (LITT): Using a laser to focus on and destroy a small portion of brain tissue, this surgery uses a minimal incision while MRI heat maps guide the laser the surgeon uses.
• Deep brain stimulation: A small device is inserted permanently into the brain to deliver electrical signals that disrupt seizure-inducing impulses.
• Responsive neurostimulation: A closed-loop device implant that monitors and responds to brain waves.

“Our multidisciplinary team considers which option is best for the individual patient, allowing us to offer excellent surgical outcomes and leading-edge care,” Dr. Sun said.