There are more than 16 FDA-approved medications for the treatment of epilepsy. Medical treatment is the most common form of therapy for people with epilepsy, many of whom are seizure-free. Most of these medications are only appropriate for certain types of epilepsy, and some medications can make certain seizures worse rather than better; so selecting the best medication requires a detailed understanding of the person’s seizure types and the underlying cause for their epilepsy.
When medications are not effective, several surgical treatment options are available for people with epilepsy. In most instances, the area in the brain that is generating seizures is removed, often resulting in freedom from seizures. When removal of part of the brain isn’t felt to be safe or likely to be effective, implantation of a device that sends electrical stimulation to a nerve in the neck may reduce seizures.
Deciding who may benefit from surgery requires extensive testing to identify where seizures are coming from and what the risks associated with surgery are. Each patient’s evaluation is individualized according to their specific circumstances, and is reviewed and discussed at a weekly multidisciplinary epilepsy team meeting with input from epileptologists, neurosurgeons, neuropsychologists and neuroradiologists
Surgical procedures may include:
- Standard temporal lobe resections
- Selective amygdalohippocampectomy
- Temporal and extra-temporal neocortical resections
- Lesionectomy of tumor or other malformation
- Corpus callosotomy
- Vagus nerve stimulator (VNS) implantation
- Brain mapping and corticography of eloquent cortex to spare function