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Preparing for Epilepsy Surgery

Epilepsy surgery offers an opportunity for some patients with intractable epileptic seizures to gain seizure control. As part of the process of evaluation for epilepsy surgery, all patients undergo video EEG monitoring, where the goal is to record at least three typical seizures to confirm where seizures are starting. Along with video EEG monitoring, patients also undergo brain imaging studies such as an MRI and PET scan. Patients also may have an ictal SPECT scan, if needed, for better localization of their seizures.

To determine memory patterns, patients will undergo extensive memory testing using specific neuropsychological tests. If these tests result in good localization of seizures and indicate that surgery will be safe without undue risk to strength, sensation or memory, patients are given the option for epilepsy surgery. Sometimes, because initial tests do not localize seizures or brain function adequately, patients undergo intracranial electrode monitoring. Intracranial electrode monitoring, which requires an operation to place electrodes, is followed by video EEG monitoring to record seizures.

If seizures are well-localized, and patients want to proceed with epilepsy surgery, they will meet with their treating neurologist and neurosurgeon to review the details of the planned neurosurgical procedure. In the best case scenarios, there will be a 70 percent chance of complete seizure freedom after epilepsy surgery, with a 25 percent chance of significant reduction in seizures. There is a five percent chance of seizures continuing unchanged.

While prognosis for seizure control can be excellent after epilepsy surgery, patients typically continue to take anti-epileptic medications after surgery to reduce the risk of recurrent seizures. Often, if seizures remain well-controlled for two years after epilepsy surgery, anti-epileptic medication regimens can be simplified.

To make an appointment with a Washington University epileptologist, neurologist or neurosurgeon at Barnes-Jewish Hospital, call 855.925.0631.

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