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Is Surgery Right for Your Epilepsy, Tremor or Other Neurological Condition?

Cleveland Clinic

If you have epilepsy, a movement disorder or another neurological condition, you should know all the treatment options available to you.

Some patients used to shy away from neurosurgery, assuming it was too risky or only for dire circumstances. But Cleveland Clinic is making specialized procedures more accessible for people with brain and spine disorders.

The nation’s No. 4 neurology and neurosurgery program according to U.S. News & World Report, Cleveland Clinic helps patients better manage life-threatening disorders and conditions that limit their quality of life. Here’s a look at some innovative treatment options that are providing great outcomes for patients.

Surgery for epilepsy

SEEG-Guided Surgery Refractory Epilepsy Multifocal Spikes
Cleveland Clinic

When medications aren’t enough to control epileptic seizures, surgery often can bring relief.

Although it’s been an established treatment for epilepsy for more than 60 years, surgery isn’t always considered for all patients who might benefit from it. This is unfortunate because the risks of epilepsy surgery are generally low — much lower than living with uncontrolled epilepsy — thanks to sophisticated neurophysiological, imaging and minimally invasive surgical techniques. The outcomes can be life-changing, and include freedom from seizures in a large number of people in whom multiple anti-epileptic medications have failed.

Cleveland Clinic is one of the largest epilepsy centers in the world. In 2018, its neurosurgeons performed more than 400 epilepsy surgery procedures, the highest total in the nation. About 60 percent of their surgery patients stop having seizures long-term — the best rate in the nation. Even more report improved quality of life.

A team of experts carefully selects patients for epilepsy surgery, which can involve targeted surgical removal of the brain tissue causing seizures or placement of a neurological “pacemaker” that can quiet down the seizures.

Deep brain stimulation for movement disorders

Brain activity
Cleveland Clinic

Cleveland Clinic’s Center for Neurological Restoration is a world leader in using deep brain stimulation (DBS) to treat movement disorders. A Parkinson’s Foundation Center of Excellence, Cleveland Clinic has used DBS for well over 1,000 patients with Parkinson’s disease, essential tremor and dystonia. It also was first in the world to use DBS for stroke rehabilitation in 2016.

DBS involves implanting electrodes in a patient’s brain. The electrodes are connected to a stimulator and carry impulses generated in the stimulator to block brain activity that causes muscle spasms and other symptoms. To make the DBS implantation procedure more comfortable, neurosurgeons at Cleveland Clinic can perform it while patients are asleep, under general anesthesia, in a special operating room equipped with its own MRI machine.

Other functional neurosurgery options include noninvasive approaches like MRI-guided focused ultrasound and Gamma Knife® radiosurgery for tremors — which use ultrasonic waves and beams of radiation instead of surgical incisions — as well as spinal cord stimulation for pain syndromes.

Options abound for brain blood vessel disorders

Brain surgery procedure
Cleveland Clinic

Surgery also plays an important role in treating bleeding or blood clotting disorders in the brain, although these conditions increasingly can be managed with less-invasive procedures.

Brain aneurysms may be treated with open brain surgery or with minimally invasive “endovascular” procedures — in which a catheter is placed into an artery (usually in the leg or wrist) and threaded up through the circulatory system to the brain — or sometimes with both approaches in combination.

A similar mix of open surgery and/or endovascular options can be considered for an arteriovenous malformation (AVM) — an abnormal tangle of blood vessels in the brain or spine — which also may be treated noninvasively with Gamma Knife radiosurgery.

Experts in Cleveland Clinic’s Cerebrovascular Center — who treat AVM, brain aneurysm, stroke, and carotid and intracranial stenosis, among other conditions — consider all these options for the more than 1,700 surgical procedures they perform each year, tailoring the choice to each patient’s specific situation.

From the brain to the spine

Spine model
Cleveland Clinic

Much of the art of spine surgery lies in determining when it’s truly needed after physical therapy, spinal injections and other treatments have done all they’re going to do. The doctors at Cleveland Clinic work in collaborative groups so they can together choose the treatment that is best for each patient’s neck or back pain problems.

One instance where spine surgery often has a clear role is for treating complex spine deformities, which can cause significant pain and disability. Surgery to correct spine deformities frequently involves placing metal implants to stabilize the spine. Visiting a spine program with lots of experience in these operations can be critical to treatment success.

Spine tumors are another case where spine surgery is typically central to effective treatment. At Cleveland Clinic, all patients with spine tumors have their case reviewed in depth by a spine tumor review board made up of specialized and experienced spine surgeons, cancer specialists and many other experts. Each specialist weighs in to help shape an individualized treatment plan for the patient that includes how best to operate on the tumor and how other treatments will complement the surgery.

Other scenarios where spine surgery is often the right choice involve compression of the spinal cord or spinal nerves (referred to as spinal stenosis) causing arm or leg pain, weakness, numbness or imbalance. Many surgical options are available to treat these problems, and it’s important to match the right surgery to the right patient. At Cleveland Clinic, all spine surgeons are highly skilled in each type of surgery and work as a team to meet patients’ treatment needs with the least invasive procedure.

Making the right choice

Today’s advanced neurosurgery options can improve the outlook for patients with even the most complex brain and spine disorders.

To see if you’re a candidate for one of these therapies, consider an evaluation by the experts at Cleveland Clinic Neurological Institute. A team of some of the nation’s top neurologists, neurosurgeons, neuroradiologists and neuropsychologists will review your condition and recommend the best treatment options for you.

For a second opinion from a leader in neurological care, call Cleveland Clinic at 866-594-3553.