For most children, medication is all that is needed to control seizures. However, some children continue to have seizures
even after trying two or more different medications or a combination of medications. Seizures that fail to respond to two
or more anti-epileptic drugs are called medically refractory seizures.
When medication fails to control seizures, surgery (an operation) may be considered to remove or disconnect the part of the
brain that is generating the seizures. This is called the epileptogenic (seizure-causing) region of the brain.
With improvements in imaging technology and EEGs, it is now easier for doctors to define the epileptogenic areas of the brain.
As a result, surgery has become a well-established method of treatment for adults. Increasingly, children with intractable
epilepsy that cannot be controlled with medication are also being considered for surgery. There appear to be some advantages
to doing epilepsy surgery in children, rather than waiting for adulthood:
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Children's brains are more plastic than adults' brains, with a greater ability to compensate for portions removed during surgery.
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In some children, treating seizures earlier may prevent brain damage or changes from repeated seizures and their detrimental
effects on cognition and development.
Early surgery for seizures may also be recommended if the cause of seizures is identified to be a brain lesion that is growing,
such as a tumour.
Although surgery will not help every child with uncontrolled seizures, it can be a very effective treatment. Various studies
suggest that 57% to 69% of babies, children, and teenagers treated with surgery become seizure-free. Between 11% and 24% continue
to have frequent seizures.
This page contains an overview of the surgical process, from determining whether your child is a candidate for surgery to
post-operative care. You will find more detail about each step and each surgical procedure in the other pages in this section;
click the links on the left to learn more.
Who is surgery considered for?
Surgery for epilepsy is considered when:
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The child has seizures that will not improve by themselves as the child gets older.
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Drugs have been tried and have failed to control a child's seizures. Often at least two individual medications separately
(monotherapy) and one combination of medications (polytherapy) will have been tried and will have failed to control seizures.
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The epileptogenic or seizure-causing region of the brain can be clearly identified and can be removed or disconnected with
minimal risk of harming the child.
With advances in knowledge and technique in both diagnostic tools and surgery, broader spectrums of people with epilepsy are
now being considered for surgery.
Determining whether your child is a candidate for surgery
If your child is being considered for epilepsy surgery, a detailed pre-surgical evaluation will be done and the results will
be thoroughly analyzed to determine:
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whether your child will be helped by surgery
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the type and exact location of the operation
The pre-surgical evaluation may consist of one or more procedures. For details, please see the page on "Pre-surgical Evaluation"
in this section of the site.
Making a decision about surgery
If the doctors determine that surgery is an option for your child, you should discuss it with the doctor and with your child
(if your child is old enough) and think the decision over carefully. You will need to consider the possible improvements from
the surgery, the risks of surgery, the risks if your child does not have the surgery, and any alternative treatments. For
more information, please see the page on "Making a Decision about Surgery" in this section of the site.
Preparing for surgery
In the days before the surgery, if you decide to go ahead, the surgeon will discuss the operation with you and your child.
This will include the pre-operative steps, the procedure, what is involved in recovery, risks, and what to expect afterwards.
An anaesthetist will explain the anaesthetic procedure, the associated risks, and any possible after-effects. Other health
care professionals may also be involved at this stage to discuss home care and on-going issues with you and your child. You
should ask any questions you have at this time.
When you agree to the surgery, you will need to give your consent by filling out a consent form.
When you agree to the surgery, you will need to give your consent by filling out a consent form; for more information, please
see the page on "Consent" in this section of the site.
You will need to prepare your child for the surgery by discussing and explaining the surgery to your child in a sensitive,
calm, and age-appropriate manner. For more information, including suggestions about how and when to discuss surgery with children
of different ages, please see the page on "Preparing for Surgery" in this section of the site.
Full blood tests and a coagulation profile need to be done before surgery. Some AEDs inhibit the blood's clotting mechanisms
and need to be stopped before surgery. The team will discuss these things with you and give you instructions for tapering
off your child's medication.
What happens during surgery
On the day of the surgery, your child will not be able to eat for several hours beforehand. When the surgeons and the team
are ready for her, she will be given an intravenous (IV) line and taken into the operating room. You will be able to stay
in the waiting room while your child is in the operating room. For more information, please see the "Before Surgery" page
in this section of the site.
Your child will be put to sleep under general anaesthesia. For more information, please see the page on "Anaesthetic" in this
section of the site.
A portion of the child's hair may be cut or shaved. You can ask the surgeon about this before the surgery, to help prepare
your child. The first step of the surgery is called a craniotomy, in which a part of the scalp and bone will be removed and
the dura membrane pulled back to expose the brain. Where the incision is made and which part of the brain is exposed depends
on the area to be operated on.
There are generally two types of surgery for epilepsy:
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Surgery which removes the epileptogenic portion of the brain is called resection or resective surgery. Examples of resection
are temporal lobectomy, extratemporal resection, and hemispherectomy.
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Surgery that disconnects a portion of the brain to prevent the spread of seizures, without removing any brain tissue, is called
disconnection surgery. Examples of disconnection surgery are corpus callosotomy and multiple subpial transection.
Each of these procedures is described in more detail in this section of the site. Click the links on the left to learn more.
During the operation, a special type of EEG may be done to help the surgeon and epilepsy team to finely locate and remove
or disconnect only those portions of the brain causing the seizures. This type of EEG is called electrocorticography (ECoG),
because it is recorded directly from the brain surface.
After the operation, the bone will be replaced and the scalp will be sutured closed.
Your child will spend a few hours in the recovery room until he awakes, one or two days in the intensive care unit until his
condition is stable, and then about a week at the hospital. For more information about what happens in the hours and days
after surgery, please see the "After Surgery" page in this section of the site.
Rehabilitation and return to normal activity
Any hair that the surgeon may have shaved to do the surgery will grow back, and this usually covers up any scar quite well.
How quickly your child can return to school and normal activity depends on the type of surgery and its effects on your child.
Most children can return to school, at least part-time, within a month after surgery; however, some children may not be able
to return this quickly. If the surgery affected your child's motor function, language abilities, or memory, he may need rehabilitation
and therapy, either while staying in the hospital or as an outpatient. Rehabilitation may include physical therapy, occupational
therapy, speech therapy, or other forms of therapy.
Anti-epileptic drugs should be continued after the surgery, usually at the same dosages. Sometimes, the doctors may decide
to add a different drug following surgery. Sometimes the drugs can be stopped after a few seizure-free years.
Click the links on the left to learn more.