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When medications and lifestyle changes fail to provide adequate control for seizures, surgery can be an option. Epilepsy surgery can be done for patients without any identifiable lesion or structural changes seen on neuro imaging and that can work wonders for some people. But epilepsy surgery is most effective when there’s a lesion in the brain that has been identified as a cause of the person’s seizures. But even when there’s a visible lesion located in part of the brain that can be safely taken out without the person developing any weakness or cognitive dysfunction, that still doesn’t guarantee seizure freedom. It can however, change a person’s life in very positive ways. Great care is taken when evaluating someone for epilepsy surgery to make sure that the area of the brain that will be operated on doesn’t interfere with speaking or understanding language, motor functions, vision or hearing, memory, or other cognitive functions. Aside from taking out a part of someone’s brain responsible for their seizures, there are other surgical procedures available. Implanting a vagus nerve stimulator underneath the skin of the chest with the wires from the stimulator, connecting to the vagus nerve in the neck allows for burst of electrical energy through the vagus nerve up to the brain. It’s not clear how this inhibits seizures, but it’s usually as good as adding a second or third anti-seizure medication and it can reduce seizures by 20 to 40%. In doing deep brain stimulation, surgeons implant electrodes into a specific part of the brain – typically the thalamus. The electrode sends electrical pulses to the brain in order to reduce seizures. With Visualase, a laser is used to destroy the tissue in the part of the brain responsible for the seizure. Light energy is delivered to the target tissue through using a small laser catheter and as the laser light is delivered, the temperature increases and destroys the tissue. With responsive neurostimulator, the system is implanted in the skull and sends electrical stimulation to part of the brain where the seizures are coming from. When all else fails, remember that surgery may be the option that delivers seizure freedom for your patient.
