Epilepsy - Surgery

Success Rates. New imaging techniques are dramatically improving the success rates of temporal lobe surgery. Studies have shown that many patients remain seizure-free after temporal lobectomy. A 2005 study of 48 patients who had temporal lobectomy found that half were seizure-free 30 years after the surgery. Patients still need to take medications, even if seizures are very infrequent. Cure is not always possible, and some patients may still experience some seizures. Double vision is very common after the operation, but it is nearly always temporary and resolves within a few months.

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Studies are further indicating that temporal lobe surgery improves quality of life and may even prolong survival. Some experts theorize that surgery might stabilize parts of the brain that influence heart rate and may reduce the risk of sudden death, a rare complication of epilepsy.

Effects on Mental Functioning. Although surgery on the left temporal lobe does not impair intelligence to any significant degree, studies on the effects of mental functioning and behavior are unclear:

One study reported that 10% of patients experienced significant decline in language abilities while another 9% reported significant improvement. In the study, about 16% reported improvement in nonverbal mental functions.
In a study of children, surgery improved behavior in 31% of the patients and mental function in 25%. (Negative changes in personality, emotions, or behavior are uncommon following surgery.)
A study of 50 children aged 3 to 7 reported that 66% of the children were seizure free within a year after surgery. Nearly all the children showed improvement in cognitive development, and a few children?s IQ scores improved by 15 points.

In general, surgical effects on mental functioning and behavior depend on the extent and location of the surgical area.

Lesionectomy

Lesionectomy is a procedure that removes specifically abnormal tissues in certain conditions, such as the following:

Cavernous angiomas (abnormal clusters of blood vessels).
Low-grade brain tumors.
Cortical dysplasias. (This is an abnormality in fetal development in which the normal migration of nerve cells is altered for some reason.)

This local surgery, which can cure the patient's epilepsy, has become possible with the advent of advanced imaging techniques such as MRI.

Other Surgeries

Other surgical procedures called hemispherectomy and corpus callosotomy offer hope for specific patients. They include infants and young children with catastrophic seizures that occur in one or part of a hemisphere and for patients whose seizures are due to specific structural brain abnormalities or tumors.