Seizures: When Is Brain Surgery Needed?

🌟 Introduction

For most people with epilepsy, seizures are well-controlled with medication. A single pill a day allows them to live a completely normal life. However, for about **30% of patients**, medications simply do not work.

When seizures persist despite best medical efforts, it is called **"Drug-Resistant Epilepsy."** In these cases, brain surgery is not just a "last resort"—it is often the most effective cure. Dr. Atul Sharma explains when it's time to stop changing medicines and start considering surgical solutions.

💊 The "Two-Drug" Rule

When to pivot to surgery:

Medical guidelines are very clear: If a patient has tried **two appropriate anti-seizure medications** (at the right dose) and still has seizures, the chances of a third or fourth medicine working are less than 5%. At this stage, continuing to experiment with pills often leads to unnecessary side effects without stopping the attacks. This is the primary indicator that a surgical evaluation is needed.

🎯 Focal Seizures: The Ideal Candidates

Finding the source:

Surgery works best for **Focal Epilepsy**—where the seizures start from one specific "bad spot" in the brain. If we can identify this spot (called the seizure focus) and safely remove it without affecting speech or movement, the patient can be cured. Common causes found in this spot include:

• Hippocampal Sclerosis: Scarring deep in the temporal lobe (most common).
• Cortical Dysplasia: A birth defect in brain layering.
• Benign Tumors: Small growths irritating the brain.

🔍 How Do We Find the Spot?

Advanced mapping:

Before any surgery, a comprehensive "Pre-Surgical Evaluation" is done to map the brain precisely. This typically involves:

• Video EEG: Recording a seizure in the hospital to see exactly where it starts electrically.
• 3 Tesla MRI (Epilepsy Protocol): High-resolution imaging to find tiny scars.
• PET Scan: To see which part of the brain is not using energy correctly.

🏥 Types of Epilepsy Surgery

Depending on the location and type of seizures, Dr. Atul Sharma may recommend:

• Resective Surgery: Removing the small area of brain tissue causing the seizures. This offers the highest chance of a complete cure.
• Laser Interstitial Thermal Therapy (LITT): A minimally invasive laser probe burns the seizure focus through a tiny 2mm hole.
• Vagus Nerve Stimulation (VNS): For patients where the focus cannot be removed, a "pacemaker for the brain" is implanted to reduce seizure frequency.
[Image of Vagus Nerve Stimulation device]

✅ Why "Wait and See" is Dangerous

Protecting the brain:

Uncontrolled seizures are not just inconvenient; they damage the brain over time, leading to memory loss and cognitive decline. They also carry the risk of **SUDEP** (Sudden Unexpected Death in Epilepsy). Early surgery can stop this damage, allow children to develop normally, and help adults return to driving and employment.