Living with epileptic seizures can be debilitating and exhausting, especially when medicines cannot manage them. At Providence, we take time to understand your seizures. We find the best surgical treatment to prevent or reduce your seizures so that you can enjoy a good quality of life.
Our team treats more complex types of epilepsy that don’t respond to other treatments or can’t be treated with traditional epilepsy surgery. The conditions include:
- Complex epilepsy
- Medically resistant epilepsy
- Non-temporal lobe epilepsy
- Temporal lobe epilepsy
You and your care team work together to decide if epilepsy surgery is right for you. We complete several tests as part of this process and use your test results to thoroughly understand your seizures. Testing goals include:
- Identifying if one or more areas in your brain cause seizures
- Deciding if the area can be safely removed
- Determining the best treatment approach
We use advanced technology to get critical information about your seizures. This data helps your care team choose the most precise treatment for you. Some tests are non-invasive and can be completed on an outpatient basis. Others require inpatient surgery.
Your testing may include:
- Computed tomography (CT) test
- Cortical mapping
- Functional magnetic resonance imaging (MRI)
- High resolution MRI of the brain
- Invasive seizure monitoring (grid and depth electrodes)
- Long-term video electroenceophalogram (EEG) in an epilepsy monitoring unit
- Positron emission tomography (PET) test
- Wada testing
If your seizures begin in one area of your brain, an open surgery called a craniotomy or stereotactic laser surgery may be a good option.
If your seizures start in multiple areas of your brain, are too close to important neurological structures or we cannot identify a trigger point, other treatment options like a Neuropace procedure or vagus nerve stimulation are available.
What to Expect During Craniotomy
A craniotomy is open brain surgery performed under general anesthesia. Your neurosurgeon:
- Creates a preoperative plan using MRI scans of your brain
- Removes part of your skull to expose the brain
- Uses computer navigation based on your MRI scans to locate the precise area of brain tissue to remove
- May use tests during surgery like brain cortex stimulation to avoid damaging motor or language centers in the brain
- Removes the brain tissue where seizures begin
- Replaces the portion of skull with plates and screws
- Closes the scalp with sutures
- You recover in the hospital for two to five days
- We monitor you for any side effects or seizures
- You continue to take your seizure medicines
- You see your care team for regular follow-up appointments
What to Expect During Stereotactic Laser Ablation
If your seizures are localized to one area of onset or are away from areas of important brain function, stereotactic laser ablation may be the right treatment for you.
We perform this minimally invasive procedure under general anesthesia. Your surgeon:
- Makes a half-inch incision in the scalp
- Drills a small hole through the skull
- Passes a fiber optic laser probe through the hole to reach the target area of your brain
- Uses the laser to selectively burn the brain tissue that causes seizures
- Uses an intraoperative MRI to precisely guide the laser and see what’s happening inside your brain in real time
- May repeat the laser burning from different angles to achieve complete ablation of a more complex target area
- Removes the laser and closes the incision in your scalp with a single stitch
- We monitor you in the hospital after surgery.
- You return home the day after surgery.
- You continue to take your epilepsy medicines.
- You see your neurosurgeon and neurologist for regular follow-up appointments.
What to Expect During Neuropace Surgery
If your seizures begin in multiple areas or start in tissue important for normal brain function, Neuropace surgery may be an option for you.
Neuropace uses electrodes and a responsive neurostimulator device to monitor your brainwaves and respond to unusual activity that can lead to a seizure. The device sends short electrical pulses to stop abnormal activity. This often occurs before you feel seizure symptoms.
We perform Neuropace implantation under general anesthesia. Your surgeon:
- Makes an incision in your scalp where the neurostimulator will be implanted
- Removes a piece of skull to accommodate the neurostimulator
- Makes separate, small incisions at locations where the electrodes will enter the brain through the skull
- Precisely places the electrodes to best recognize and respond to seizure activity
- Tunnels the electrode wires under the skin of your scalp to the neurostimulator
- Connects the electrodes to the neurostimulator device
- Closes the incisions with sutures and staples
- We monitor you in the hospital after surgery
- You return home the day after surgery
- You continue to take your epilepsy medicines
- You see your neurosurgeon and neurologist for regular follow-up appointments
- Your device records your seizures for several weeks
- Your neurologist adjusts the device to recognize and respond to your seizures
- Your seizures begin to improve a few months after surgery as the device learns to respond to your brain activity
For many patients, Neuropace reduces seizures and provides better cognitive function, quality of life and mood. The device does not cause side effects like many seizure medicines do, such as cognitive impairments, dizziness or drowsiness.
What to Expect During Vagus Nerve Stimulation Surgery
Vagus nerve stimulation prevents seizures by sending regular pulses of electrical energy to the brain through the vagus nerve. Vagus nerve stimulation uses a neurostimulator (like a heart pacemaker) implanted under the skin of your chest, and an electrode that connects to the vagus nerve in your neck.
We perform vagus nerve stimulation surgery under general anesthesia. The procedure takes about 90 minutes.
- Makes an incision in the left chest near the collar bone to place the neurostimulator
- Makes a second incision on the left side of the neck
- Separates the vagus nerve from the surrounding structures
- Winds the electrode around the vagus nerve and secures it in place
- Passes the electrode wires under the skin to the chest incision and connects it to the neurostimulator
- Closes both incisions with sutures and surgical glue
- You return home the same days as your surgery.
- Your neurologist activates the stimulator two to three weeks later at a follow-up appointment.
- Your neurologist:
- Determines the right strength and timing of impulses to meet your needs.
- Programs the settings with a wand that is placed over the skin where the neurostimulator is implanted.
If needed, you can activate your device with a special magnet to send a stimulation if you experience pre-seizure symptoms such as auras. This may stop the seizure.
The stimulator battery lasts about five years. Your doctor can replace it during a brief outpatient surgical procedure.