Epilepsy Surgery is carried out by a neurosurgeon to treat epilepsy in children where anti-epileptic medications have not achieved adequate seizure control, referred to as medically refractory epilepsy or drug resistant epilepsy. There are many types of epilepsy surgery possible, each with its own indication and goals.
Your child will undergo extensive tests prior to referral for epilepsy surgery including radiological scans such as MRI, video telemetry EEGs, neuropsychological and other therapy assessments.
Your child’s suitability for epilepsy surgery is determined by a multidisciplinary team of specialists who will discuss their case at the national epilepsy surgery review meeting (ESRM) hosted weekly in Beaumont Hospital. The ESRM is attended by neurologists, neurosurgeons, neurophysiologists and epilepsy surgery nurse specialists.
There are several possible recommendations from the ESRM depending where the specialist think the seizures are coming from.
- Recommend to offer surgery
- Surgery is not suitable
- More tests required
- Resective Epilepsy Surgery
This is a neurosurgical procedures to remove the area of the brain where seizures originate with the aim of stopping seizures. This tends to be offered if there is good agreement with the tests results indicating that seizures are coming from a single area, called focal epilepsy.
- Palliative Epilepsy Surgery
If the results indicate that the seizures maybe coming from a wider area or multiple areas then procedures to reduce seizure frequency and intensity can be offered. There are two main types of procedures for this scenario, disconnective procedures and neuromodulation. A disconnection procedure involves isolation one part of the brain or side of the brain from the rest of the brain to stop the spread of seizures and includes hemispherotomy, corpus callostomy, temporal parietal occipital disconnections or tailored disconnective procedures.
The most common form of neuromodulation is implantation of Vagal Nerve Stimulator. This is an implanted device that stimulates a nerve in the neck which has many connections in the brain. This results in a gradual improvement in seizure burden over a period of time is a substantial number of patients.
- Intracranial EEG
This sometimes referred to as a phase 2 study. It is offered when the first phase of preliminary test results are inconclusive but the specialists believe the seizure are coming from an area where some form of surgery maybe possible. This is a special diagnostic test which is a surgical procedures. Electrodes are placed on the surface of the child’s brain or deep into their brain. Your child will then be monitored for seizures over a period of time to help identify the area of the brain giving rise to seizures. At the end of this study the results are analyzed and a recommendation follows.
- Following case discussion at the ESRM if your child is a candidate for epilepsy surgery you will receive an appointment for the next epilepsy surgery clinic (ESC) in CHI at Temple St. These are held on the 2nd Tuesday of every month.
- At the ESC clinic you and your child will meet with Mr Kieron Sweeney and Prof Donnacha O’Brien, consultant neurosurgeons who specialise in epilepsy surgery, one of the neurosurgery clinical nurse specialists and the neurosurgery co-ordinator Emma Holohan.
- Your child’s epilepsy surgery will be discussed in detail with you and your child and any pre- operative tests or investigations arranged. Pre-operative bloods may be taken in the Phlebotomy dept on the same day and if required a MRSA screen also.
- Following your appointment if a decision is made to proceed with the epilepsy surgery your child will be added to the elective neurosurgery waiting list. The co-ordinator will contact you regarding any further pre op investigations or preparations and when a date for surgery is scheduled. As an elective procedure this date may be changed to facilitate emergency surgeries. Your child’s other medical teams will be updated about their clinic appointment and when their surgery takes place.
Resective Surgery
Your child will be reviewed at the ESC 6 weeks and 6 months after their epilepsy surgery. Some children may require a long term follow up with yearly reviews at the ESC, repeat MRIs, neuropsychology assessment etc.
Palliative Surgery
- VNS
Following implantation with a VNS device your child will attend their neurology team 2 weeks after surgery for switching on of the device. They do not receive any routine follow up at ESC.
When their VNS battery requires replacement their neurologist will contact the ES team to arrange a surgery date and the neurosurgery co-ordinator will liaise with you regarding this.
- Other palliative surgeries
Your child will be reviewed at the ESC 6 weeks and 6 months after their epilepsy surgery. Some children may require a long term follow up with yearly reviews at the ESC