Epilepsy Surgery

The Epilepsy Surgery Program

Wake Forest School of Medicine Comprehensive Epilepsy Program is known internationally for the medical management of epilepsy. With the addition of the Epilepsy Monitoring Unit at the Wake Forest Baptist Medical Center, the program continues a tradition of excellence in the complete evaluation and management of patients with problem epilepsy.

Our multi-disciplinary staff includes epileptologists, neurosurgeons, neuropsychologists, nursing specialists, social workers, pharmacologists and EEG technologists. Together, they address all aspects (medical, social and psychological) of patients with difficult-to-control seizures.

Surgery

Over the last 25 years there have been many advances in the treatment of epilepsy, including various surgical methods. There are currently 3 types of operations performed to reduce or stop seizures:

Lobectomy

Lobectomy removes all or part of one of the lobes of the brain in which seizures begin. The most common type is a temporal lobectomy which removes seizure-generating tissue from the temporal lobe. Seizures with origins in other areas of the brain may also be treated with this type of surgery.

Corpus Callosotomy

Corpus Callosotomy operation involves cutting the connections between the two brain hemispheres to prevent seizures beginning in one side from spreading to the other. This procedure is most often performed when a patient is having experiencing uncontrolled drop seizures or severe generalized tonic-clonic seizures.

Hemispherectomy

Hemispherectomy involves the removal of all or almost all of one hemisphere of the brain. It is only done in cases where there is a severely diseased, seizure-causing hemisphere.

When Surgery Is Necessary

For patients who are refractory to medication, epilepsy surgery is an option that can dramatically improve the quality of life. In addition to video-EEG monitoring, imaging techniques such as magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission tomography (SPECT) help pinpoint the seizure focus even when lesions do not appear on routine imaging. Neuropsychological tests and MEG and intracranial EEG electrodes also offer important clues to the seizure focus.

Once the seizure focus is located, the patient may be a candidate for surgical resection. A temporal lobectomy, which involves the removal of the brain portion responsible for seizure activity, achieves complete seizure control in 70 to 80 percent of patients and a significant reduction in the frequency and severity of seizures in another 15 to 20 percent.

Other techniques, such as corpus callosotomy, are performed in selected patients who are ineligible for the resection of brain tissue. In this procedure, the white matter tract connecting the 2 halves of the brain is cut to halt the spread of seizures and to limit their severity. Significant improvement for this select group has been achieved with this procedure.

Monitoring

Up to 20 percent of patients admitted to epilepsy monitoring units have non-epileptic events. The primary goal, then, is to confirm the diagnosis of epilepsy. Often conventional diagnostic techniques are not conclusive. Simultaneous video and electroencephalographic (EEG) monitoring, 24 hours a day in our Epilepsy Monitoring Unit, enable personnel to record and correlate complete clinical behavior, providing the information needed for proper diagnosis and treatment.

To learn more about monitoring, select a link below:
Phase I Monitoring
Phase II Monitoring

The Facility

Our 6-bed unit is located in the Ardmore Tower of North Carolina Baptist Hospital. Each private room contains video-EEG monitoring equipment and is large enough for a family member to remain with the patient at all times. Monitored information is sent to a central control room and recorded for later analysis by epileptologists. Patients may socialize and take part in recreational activities in the facility's pleasant day room while being observed on video and EEG.

Your Stay

Patients are required to have a family member present at all times.

Outpatient & Mobile Video-EEG Monitoring

For some, monitoring on an outpatient basis is recommended. For these patients, it is possible to continue video-EEG monitoring on an appointment basis, without the necessity of checking into the hospital. For patients hospitalized but unable to be transferred to the EMU, mobile monitoring equipment is utilized.

Medications

Once the diagnosis of epilepsy is established, the physicians and support staff reassess the adequacy of drug treatment for adjustment or change. As an active participant in the development of new anti-convulsant drugs, our Comprehensive Epilepsy Program can offer eligible patients an opportunity to participate in studies of experimental medications.