Surgical treatment of epilepsy is indicated in cases of refractory epilepsy, when antiepileptic drug therapy does not provide adequate seizure control. The main goal of surgery is complete elimination or a significant reduction in seizure frequency, leading to improved quality of life for the patient.
Indications for surgical treatment of epilepsy
- Refractory epilepsy. Lack of seizure control despite the use of two or more antiepileptic drugs at adequate doses.
- Localized epileptogenic focus. The ability to clearly identify the brain area responsible for seizure generation.
- Neurological complications. Progressive cognitive impairment caused by frequent seizures.
- Severe psychosocial consequences. Reduced ability to work, significant decline in quality of life.
- Life-threatening seizures. For example, episodes of status epilepticus.
Preoperative evaluation
A comprehensive pre-surgical assessment includes:
- Electroencephalography (EEG). Identification of the epileptogenic zone.
- Magnetic resonance imaging (MRI). Detection of structural brain abnormalities.
- Video-EEG monitoring. Simultaneous recording of seizures and brain electrical activity.
- Positron emission tomography (PET). Assessment of cerebral metabolic activity.
- Neuropsychological testing. Evaluation of cognitive functions.
- Functional MRI (fMRI). Localization of eloquent brain areas responsible for speech and motor function.
Main surgical treatment options
- Resective surgery. Removal of the epileptogenic focus.
- Functional (disconnective) surgery. Interruption of neural pathways to prevent seizure propagation.
- Implantation of neurostimulation devices. Suppression of epileptic activity using electrical stimulation.
Resective procedures
- Lobectomy. Removal of a brain lobe containing the epileptogenic focus, most commonly the temporal lobe. Effectiveness: up to 70–80% of patients achieve significant seizure reduction.
- Amygdalo-hippocampectomy. Resection of the amygdala and hippocampus in temporal lobe epilepsy, typically in patients with hippocampal sclerosis.
- Focal corticectomy. Removal of a limited cortical area responsible for seizure onset.
- Hemispherectomy. Removal or functional disconnection of one cerebral hemisphere. Most often performed in children with severe epilepsy caused by extensive structural abnormalities.
Functional (disconnective) procedures
- Multiple subpial transections. Sectioning of horizontal cortical fibers to prevent seizure spread while preserving cortical function. Used when the epileptogenic zone is located in eloquent cortex.
- Corpus callosotomy. Sectioning of the corpus callosum to prevent seizure generalization. Particularly effective for atonic seizures.
Neurostimulation therapies
- Vagus nerve stimulation (VNS). Implantation of a device delivering electrical impulses to the vagus nerve. Reduces seizure frequency by approximately 50–60% in most patients.
- Deep brain stimulation (DBS). Implantation of electrodes into specific brain targets, such as the thalamus, to modulate pathological electrical activity.
- Responsive neurostimulation (RNS). A device that detects epileptic activity in real time and delivers targeted stimulation to suppress seizures.
Benefits of surgical treatment of epilepsy
- Reduction or cessation of seizures. In most patients, seizure frequency decreases by 70–90%.
- Improved cognitive function. Reduced seizure burden leads to better attention and memory.
- Improved quality of life. Enhanced social integration and restoration of work capacity.
- Reduced need for medication. Many patients can decrease antiepileptic drug dosages after surgery.
Postoperative rehabilitation
- Follow-up with an epileptologist. Adjustment of antiepileptic medication.
- Physical therapy and cognitive rehabilitation. Recovery of impaired functions.
- Psychological support. Management of anxiety and adaptation to life with reduced or absent seizures.
The success of epilepsy surgery depends on accurate diagnosis, precise localization of the epileptogenic focus, and expert surgical execution. Early referral to specialized centers and strict adherence to postoperative recommendations significantly increase the likelihood of favorable outcomes and long-term seizure control.
In Belarus, surgical treatment of epilepsy is performed in leading medical centers equipped with advanced technology. Highly qualified neurosurgeons and epileptologists provide an individualized approach for each patient. High standards of medical care combined with affordable costs make Belarus an attractive destination for epilepsy surgery for patients from different countries.
