Epilepsy operation in Türkiye

In most cases, Epilepsy operation in Türkiye have a high success rate, primarily depending on the patient’s condition and the surgeon’s expertise.

Some cases may not respond well to surgery, while others have a very high success rate for epilepsy surgery.

You can contact REHABTÜRK doctors to learn about the success rates and costs of the procedure.

What is Epilepsy Surgery?

Epilepsy surgery is a term for various types of brain surgery (also called neurosurgery) performed on some people with epilepsy to stop or reduce their seizures.

There are different types of epilepsy surgeries in Türkiye. One type involves removing a specific area of the brain believed to be causing the seizures. Another type involves disconnecting a part of the brain that causes seizures from the rest of the brain.

When is a Person Considered for Epilepsy Surgery?

For some people, surgery can stop or significantly reduce the number of seizures they experience. It may be considered when anti-seizure medications (AEDs) have been tried and failed to stop seizures or significantly reduce them.

Can I Have Epilepsy Surgery?

Epilepsy surgery may be an option for both adults and children if:

• Several medication treatments have been tried, and none of them have stopped or significantly reduced your seizures.
• A specific cause for your epilepsy can be found in a certain area of the brain that is amenable to surgery.

Whether you are a suitable candidate for epilepsy surgery is something you may want to discuss with your general physician or neurologist. If you meet these criteria and are ready for epilepsy surgery, you will need to undergo further tests before being cleared for the procedure.

How Do I Know If My Epilepsy Is Due to a Specific Cause?

One of the tests sometimes used to help diagnose epilepsy is a brain scan using MRI (Magnetic Resonance Imaging) or CT (Computed Tomography). While they use different technology, they produce an image of your brain that may reveal a specific cause for your epilepsy.

Known causes may include brain scars, malformations in brain development, brain damage from head injury, or post-infection damage like encephalitis. If a specific cause is found, it is referred to as “epileptogenic lesion.” Epileptogenic lesions can vary in each person.

Pre-Surgery Tests for Epilepsy Surgery in Türkiye

If you are referred for surgery, you will likely go to a specialized center to undergo pre-surgical tests. There are several different pre-surgery tests you may have before getting clearance for the surgery.

These tests may include additional MRI scans, EEG (Electroencephalogram), and Video EEG monitoring.

Other types of scans that follow a chemical injected into the body may also be used. This may provide detailed information about the origin of seizures in the brain.

Memory and psychological tests are also used to determine how your memory and lifestyle may be affected after the surgery. These types of tests also help doctors understand how well you may adapt to the impact of this type of surgery.

The results of these tests will help confirm:

• Whether surgeons can access and safely remove the epileptogenic lesion during the surgery without causing new problems.
• Whether other parts of your brain may be affected by the surgery, such as areas that control speech, vision, movement, or hearing.
• If you have a good chance of seizure cessation due to the surgery.
• If you have any other medical conditions that might prevent you from having this type of surgery.

The results of pre-surgery tests will help you and your neurologist determine whether surgery is a suitable option for you and what the outcome of the surgery might be.

For many people, the results indicate that surgery is not an option. The majority of people recommended for epilepsy surgery, and those who undergo these tests, may not be eligible for the surgery.

If Epilepsy Surgery is Necessary

Undergoing any type of brain surgery is a significant decision, and you may have many questions or concerns to discuss before making a decision. Your doctors are accustomed to this process as it is an essential part of epilepsy surgery preparation.

To provide you with a comprehensive understanding when deciding on epilepsy surgery, your doctor will explain the potential risks of the specific surgery you will undergo. While your doctor can provide you with information and advice, the final decision is yours.

To give you time to discuss your feelings about surgery, you may be offered some form of pre-surgery counseling.

What Are the Possible Risks of Epilepsy Surgery?

For any type of surgery, there are potential risks related to how an individual responds to anesthesia or any complications that may occur during the procedure.

Risks for epilepsy surgery vary depending on the type of surgery a person undergoes. The most common type of epilepsy surgery involves removing part of the temporal lobe.

Possible risks for this type of surgery may include memory problems, partial loss of vision, depression, or other mood issues. These risks may vary from person to person and may be temporary in some cases.

For some people, their memory and mood may improve after epilepsy surgery. Thus, having an opportunity to ask questions to the medical team before the surgery is essential.

Can I Change My Mind?

You may feel enthusiastic about surgery and the positive impact it could have on your life, or you may feel anxious about it. Both feelings are entirely natural and expected. You may also find that you’ve changed your mind about undergoing surgery for any reason, and that’s okay – it’s a significant decision, and you have the right to decline surgery if you do not wish to proceed.

What Are the Types of Epilepsy Surgery?

Temporal Lobectomy:

The largest part of your brain, the cerebrum, is divided into four sections called lobes: frontal, parietal, temporal, and occipital. Temporal lobe epilepsy, where the seizure focus is in the temporal lobe, is the most common type in teenagers and adults. In a temporal lobectomy, brain tissue in this area is cut to remove the seizure focus. The resection involves removing brain tissue from areas outside the temporal lobe as well.

Frontal Lobectomy:

Frontal lobectomy refers to removing an area in the frontal lobe where seizures begin. It is the second most common site for epilepsy surgery.

• The frontal lobes function in brain control, such as motivation, attention, focus, organization, planning, mood, and impulse control.
• People with frontal lobe seizures may experience problems with these functions before surgery.
• It is important to understand that changes in these brain functions may also occur after surgery.

Success rates for frontal lobectomy are not as high as those for temporal lobectomy. For many people with drug-resistant epilepsy, after surgery:

• Up to 50% become seizure-free or have seizures that cause a loss of awareness or abnormal movements.
• 20% to 40% may continue to have seizures affecting cognition (focal impaired awareness or convulsive seizures). However, this group experiences a significant reduction in seizure frequency.
• A few people have no improvement in seizure control.

Although the success rate of frontal lobectomy is not as high as for those who underwent temporal lobectomy, 70% of people have significant improvement in seizure control. Most people will still need to continue taking anti-seizure medications. Over time, with guidance from an epilepsy doctor, they may be able to decrease the dose they need.

Occipital and Parietal Lobectomy:

The occipital and parietal lobes are located in the back (posterior) part of the brain. An occipital or parietal lobe resection is a surgical procedure to remove a portion or one of these lobes.

In most cases, this type of surgery is performed when an area within these lobes is found to have an abnormal structure or lesion. This type of epilepsy surgery is likely to be successful when it involves structural abnormalities such as scar tissue.

Lesionectomy:

This surgery removes brain lesions – areas of injury or abnormality like tumors or malformed blood vessels – that cause seizures. Typically, seizures stop once the lesion is removed.

Corpus Callosotomy:

The corpus callosum is a bundle of nerve fibers that connects the two halves (hemispheres) of the brain. In this procedure, which is sometimes called split-brain surgery, your doctor cuts the corpus callosum.

This stops the spread of seizures from one side of your brain to the other. It works best for people with severe forms of epilepsy that can’t be controlled, and who have severe, violent seizures that can lead to serious injuries.

Hemispherectomy:

In a hemispherectomy, the doctor removes one entire hemisphere, or half of the brain. In a hemispherectomy, your doctor may remove one entire hemisphere of the brain or disconnect it from the rest of the brain. They only remove a limited amount of brain tissue.

Hemispherectomy is usually performed in children younger than 13 who have one hemisphere that doesn’t work the way it should.

Multiple Subpial Transection (MST):

This procedure can help control seizures that start in areas of the brain that can’t be safely removed.

The surgeon makes a series of shallow cuts (called incisions) in brain tissue. These cuts interrupt the flow of seizure impulses but don’t interfere with normal brain function. The person’s abilities are left intact.

Vagus Nerve Stimulation (VNS):

A device is placed under your skin that sends an electrical pulse to the vagus nerve, which controls activity between the brain and major internal organs. It reduces seizure activity in some people with partial seizures.

Responsive Neurostimulation (RNS):

Doctors place a small neurostimulator in your skull, directly under your scalp. They attach one or two wires (called electrodes) to areas of your brain where seizures begin or on the surface of your brain.

The device detects abnormal electrical activity in the area and sends an electrical current. It can stop the process that leads to a seizure.

Deep Brain Stimulation:

Doctors place electrodes in a specific area of your brain. They stimulate the brain directly to help stop the spread of seizures in adults who haven’t responded to medications and aren’t candidates for other surgeries.

Laser Interstitial Thermal Therapy (LITT):

Laser interstitial thermal therapy is sometimes referred to as laser ablation surgery. During the procedure, magnetic resonance imaging (MRI) is used to precisely identify the targeted area in the brain for treatment. The laser is then accurately delivered to this area to eliminate seizure foci. All of this is done without the need to open the skull, making it a minimally invasive procedure.

This minimally invasive surgery can be effective for drug-resistant focal epilepsy due to small lesions. It has been more commonly used in people with mesial temporal lobe epilepsy resulting from mesial temporal sclerosis (scar tissue in the temporal lobe).

The most suitable candidates for this type of surgery include:

• Individuals with a clearly defined area in the brain where the seizures originate.
• People who may benefit from a less invasive approach to epilepsy surgery.

Advantages of this treatment include:

• Shorter procedure time.
• No need for craniotomy (opening the skull to access the brain).
• Shorter hospital stay.
• Potentially lower complication rates and side effects.

Early data on laser ablation surgery shows that more than half of the individuals treated with LITT became seizure-free, and this type of surgery is still under careful study. There is an ongoing multicenter clinical trial to assess the safety and efficacy of this procedure in individuals with mesial temporal sclerosis.

Radiosurgery:

Radiosurgery uses focused radiation beams precisely to treat the brain area where seizures originate (seizure foci). There are several different types of radiosurgery. Stereotactic radiosurgery, which does not require the surgeon to open the skull, is one such type. Three-dimensional imaging is used in stereotactic radiosurgery to deliver high doses of radiation to the seizure focus with minimal impact on surrounding healthy tissue.

After Epilepsy Surgery:

Immediately after the surgery, your doctors will monitor your recovery. In the first few days, you may experience significant fatigue and need to rest, as it may take some time for the anesthesia to wear off.

Some individuals who undergo brain surgery may experience seizures in the first week after the procedure – but this does not necessarily mean the surgery was unsuccessful. Seizures may occur after surgery due to the direct stress the brain experiences during the procedure, not because the person has a history of epilepsy.

The length of your hospital stay depends on the type of surgery you underwent and how your doctors assess your recovery. Generally, your doctors may expect you to return to your normal activities after about six weeks of surgery, but this is highly individual.

Post-Surgery Follow-ups:

After the surgery, most people will have follow-up appointments with their doctors to monitor their recovery and any seizure activity. The frequency of follow-up visits will be decided collaboratively by you and your doctors.

How will I know if the epilepsy surgery is successful?

Before the surgery, your medical team will discuss the goals of the surgery and its expected outcomes with you. For some individuals, “successful surgery” may mean complete cessation of all seizures, while for others, it may mean a reduction in the number or severity of their seizures. Usually, it takes around two years after the surgery to measure the success of the procedure.

Success rate of epilepsy surgery in Türkiye:

Approximately 70% of individuals (7 out of 10) who underwent temporal lobe epilepsy surgery found that the surgery stopped their seizures and made them seizure-free, while another 20% (1 out of 5) experienced a decrease in the number of seizures.

Still, around 50% of individuals (half of them) who underwent temporal lobe epilepsy surgery remained seizure-free even after 10 years of the procedure.

Epilepsy operation in Türkiye

The medical staff of surgical teams, doctors and consultants in REHABTÜRK can provide the best treatment options and free consultations – by striving to keep abreast of the latest medical technologies and methods.

Request a Free Consultation.