SURGICAL APPROACHES TO EPILEPSY: SURGERY FOR PARTIAL (FOCAL) SEIZURES – CONFIRMING THAT YOUR CHILD IS A CANDIDATE FOR SURGERY
The second step in the process of evaluating your child for surgery should take place in an epilepsy center capable of carrying out the full evaluation and the surgery.
If the center does not know your child, they will want to review his records carefully and may want to repeat EEGs and scans before deciding if further evaluation is in order. The center might also think that further trials of medication might be useful before considering further evaluation. Sometimes we find that patients referred to us have pseudo-seizures, not true seizures. Other children have multiple areas of abnormality and thus are not candidates for surgery. However, if the person is still a possible candidate, then the next step is to document that there is indeed a single seizure focus and that it is in an operable location. This will require video-EEG recording.
Video-EEG monitoring is the use of continuous monitoring of the EEG with simultaneous video recording to document both the clinical and the electrical onset of the seizures. It is essential to appropriate evaluation for surgery. The duration of this monitoring will depend on the center and on the frequency of the seizures. In general, we schedule one week in the monitoring unit, although for an individual with frequent seizures, a few days is often sufficient to analyze enough spells and determine if there is a consistent focus. If the seizures are less frequent, or if they subside in the hospital setting, as they often do, then we may withdraw one or more of the medications to permit seizures to be recorded. Since this drug withdrawal is done in the hospital setting, with trained personnel readily available should status epilepticus occur, the risk of abrupt withdrawal is minimized.
If, after careful analysis of the recorded seizures, a focus is identified, then consideration of surgery can proceed. If the abnormal area is situated far forward in the temporal or frontal lobes, areas that can be safely removed, then it may be possible to proceed directly to surgery. Surgery should never proceed, of course, until you and the surgeon have fully discussed the risks to your child, the chances of controlling the seizures, and any other questions you or your child may have.
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