Comprehensive Epilepsy Center
For patients who do not respond to medication, epilepsy surgery can dramatically improve quality of life. In addition to video and electroencephalographic (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 magnetoencephalography (MEG) and intracranial EEG electrodes also offer important clues to the seizure focus.
Locating the Seizure Focus: About the EMU
In order to locate where in the brain the seizures originate, many patients undergo monitoring in our Epilepsy Monitoring Unit.
Our six-bed unit is located in the Ardmore Tower of Wake Forest Baptist Health. 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 day room while being observed on video and EEG.
Learn more about the Epilepsy Monitoring Unit.
Epilepsy Surgery Can Be Better Than Medication
Once the seizure focus is located, a patient may be a candidate for surgical resection. Surgical removal of the epileptic focus has been successful and safe in adults and children of all ages. These surgical approaches are especially beneficial for children with epilepsy, who can be spared the learning and developmental problems associated with poor seizure control.
In the first randomized, controlled trial of surgery for epilepsy, researchers found that surgery is far more effective than medical therapy for treating drug-resistant epilepsy (New England Journal of Medicine, August 2, 2001). Complete seizure control is achieved in 70 to 80 percent of patients; another 10 to 15 percent have a significant reduction in frequency and severity.
The vagal nerve stimulator, which controls seizures by sending electrical pulses to the vagus nerve, can be implanted on an outpatient basis using a single incision. Wake Forest Baptist was instrumental in the nine-year research effort leading to the device's approval and was the first hospital in the United States to implant the device in a patient.
Primary Types of Epilepsy Surgery
Over the last 25 years, there have been many advances in the treatment of epilepsy, including various surgical methods. Today, there are 3 types of operations performed to reduce or stop seizures:
Lobectomy removes all or part of one of the lobes of the brain where seizures begin. A temporal lobectomy, the most common type of surgery, removes seizure-generating tissue from the temporal lobe. Seizures with origins in other areas of the brain may also be treated with this surgery.
- Corpus Callosotomy
A Corpus Callosotomy operation cuts the connections between the two brain hemispheres to prevent seizures beginning on one side from spreading to the other. This procedure is most often performed when a patient experiences uncontrolled drop seizures or severe generalized tonic-clonic seizures.
A Hemispherectomy removes all or almost all of one hemisphere of the brain and is only performed when there is a severely diseased, seizure-causing hemisphere.
- Laser Ablation
A thin, laser-tipped probe is inserted into the brain through a tiny hole in the skull. The surgeon views real-time MRI images of the process and is able to target the specific lesion with minimal exposure to surrounding tissue. The heat generated by the light from the laser destroys the targeted tissue. Patients who undergo the laser treatment typically need to stay only one day at the hospital, endure little to no pain, and require only a single stitch to close the incision made in the skull. Recovery is rapid.