Epilepsy Surgery
What is Epilepsy Surgery ?
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Why do you need Epilepsy Surgery ?
Epilepsy surgery is indicated for:
- Drug-resistant epilepsy: Seizures persist despite trials of at least two appropriate anti-epileptic drugs (AEDs) at optimal doses (affects ~30% of epilepsy patients).
- Focal epilepsy: Seizures originate from a specific brain area (e.g., temporal lobe epilepsy, often due to mesial temporal sclerosis).
- Disabling seizures: Frequent or severe seizures impacting quality of life (e.g., falls, injuries, social limitations).
- Identifiable seizure focus: Confirmed by EEG, MRI, or other tests, with low risk to eloquent brain areas (e.g., speech, motor).
- Specific conditions:
- Mesial temporal sclerosis (MTS): Hardening of the hippocampus, common in temporal lobe epilepsy.
- Cortical dysplasia: Abnormal brain development causing seizures.
- Tumors or lesions: Epileptogenic tumors (e.g., ganglioglioma), vascular malformations (e.g., AVMs), or scars from trauma/infection.
- Generalized epilepsy (select cases): Procedures like corpus callosotomy for drop attacks (atonic seizures).
The procedure aims to achieve seizure freedom (50–70% success rate) or significant seizure reduction, often allowing reduced medication use.
Why Do Epilepsy Surgery Costs Vary in Philippines?
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Epilepsy Surgery Procedure
- Before Surgery Evaluation:
- Diagnosis:
- Video-EEG monitoring: Captures seizures to localize the focus.
- MRI: Identifies structural abnormalities (e.g., MTS, tumors).
- Functional MRI or PET/SPECT: Maps eloquent areas (e.g., speech, motor) and seizure onset zones.
- Neuropsychological testing: Assesses cognitive function and predicts post-surgical deficits.
- Wada test (rare): Determines language and memory dominance by injecting anesthetic into one brain hemisphere.
- Intracranial EEG (if needed): Electrodes (grids/strips) are implanted to precisely localize the focus.
- Multidisciplinary team: Neurologists, neurosurgeons, neuropsychologists, and radiologists review candidacy.
- Consent: Risks, including neurological deficits, are explained.
- Diagnosis:
- Surgical Techniques:
- Resective Surgery (Most Common):
- Performed under general anesthesia, lasting 3–6 hours.
- Temporal Lobectomy/Amygdalohippocampectomy:
- For temporal lobe epilepsy (e.g., MTS), removing the anterior temporal lobe, amygdala, and hippocampus.
- A craniotomy (5–10 cm) exposes the temporal lobe; the seizure focus is resected.
- Lesionectomy:
- Removal of a specific epileptogenic lesion (e.g., tumor, cortical dysplasia).
- Extratemporal Resection:
- For frontal, parietal, or occipital foci; requires precise mapping to avoid functional areas.
- Disconnective Surgery:
- Corpus Callosotomy:
- For drop attacks, lasting 2–4 hours.
- The corpus callosum (connecting the brain hemispheres) is partially or fully cut to prevent seizure spread.
- Multiple Subpial Transection (MST):
- For foci in eloquent areas; small cuts disconnect seizure pathways without removing tissue.
- Corpus Callosotomy:
- Neurostimulation (Alternative):
- Not true surgery but often considered: Vagus nerve stimulation (VNS) or responsive neurostimulation (RNS) for non-resectable cases (less common in India).
- Intraoperative Tools:
- Electrocorticography (ECoG): Intraoperative EEG to confirm seizure focus.
- Neuronavigation: Guides resection using MRI data.
- Awake surgery (rare): For foci near eloquent areas, with patient interaction to preserve function.
- Resective Surgery (Most Common):
- After Surgery:
- ICU monitoring for 1–3 days to watch for swelling, bleeding, or seizures.
- Hospital stay: 5–7 days.
- Pain management: IV analgesics (e.g., morphine) for 1–2 days, then oral (e.g., ibuprofen).
- AEDs: Continued post-surgery; tapered after 1–2 years if seizure-free.
- Follow-up EEG/MRI at 3–6 months to assess seizure control and brain changes.
Recovery After Epilepsy Surgery
- Hospital Stay: 5–7 days; longer (7–14 days) if complications.
- Post-Surgery Care:
- Pain: Scalp discomfort for 1–2 weeks, managed with analgesics.
- Activity: Light walking on day 2–3; avoid heavy lifting for 6–8 weeks.
- Neurological monitoring: For deficits (e.g., memory, speech); temporal lobectomy may cause short-term memory issues (esp. dominant side).
- AEDs: Adjusted over months/years; some patients become seizure-free and taper off (30–50%).
- Rehabilitation: Cognitive or speech therapy if deficits persist.
- Diet: Normal diet; high-protein foods (e.g., eggs, lentils) support healing; 2–3 liters water daily.
- Follow-Up:
- Visits at 2 weeks, 6 weeks, 3 months, and yearly; EEG/MRI at 3–6 months.
- Neuropsychological testing at 6–12 months to assess cognitive outcomes.
Most resume normal activities in 6–8 weeks. Seizure freedom rates: temporal lobe epilepsy (60–70%), lesionectomy (70–80%), extratemporal (40–60%). Corpus callosotomy reduces drop attacks by 50–70% but rarely achieves seizure freedom.
Risks and Complications
- Surgical Risks: Bleeding (1–3%), infection (2–5%, e.g., meningitis), CSF leak (1–2%).
- Neurological Complications:
- Deficits (5–10%): Memory loss (temporal lobectomy, 5–10%, esp. dominant side), speech/vision issues (extratemporal).
- Hemiparesis (1–2%): Weakness, depending on resection area.
- Procedure-Specific:
- Corpus callosotomy: Disconnection syndrome (e.g., difficulty coordinating hands, 5–10%).
- Persistent seizures (20–40%): Incomplete focus removal or multiple foci.
- General Risks: Anesthesia reactions, blood clots (DVT, 1–2%).
- Long-Term: Cognitive decline (esp. temporal lobectomy), need for lifelong AEDs in some cases.
Report fever, severe headache, or new neurological deficits promptly.
Frequently Asked Questions (FAQs)
Who is a candidate for epilepsy surgery?
Patients with drug-resistant focal epilepsy, an identifiable seizure focus, and acceptable risk to functional brain areas.
Does epilepsy surgery guarantee seizure freedom?
No, but 50–70% achieve seizure freedom; 20–30% have significant reduction; 10–20% see no change.
Will I lose brain function?
Risk exists (5–10%); mapping and intraoperative monitoring minimize deficits, but memory or speech issues may occur.
How soon can I resume activities?
Light activities in 2–3 weeks, normal routines in 6–8 weeks.
Is epilepsy surgery covered by insurance in India?
Yes, for drug-resistant epilepsy; confirm with your provider.
Signs of complications?
Fever, severe headache, swelling, or new neurological deficits.
Can seizures return after surgery?
Yes, 20–40% risk, esp. if the focus wasn’t fully removed or new foci develop.
Lifestyle changes post-surgery?
Avoid heavy lifting for 6–8 weeks, continue AEDs as advised, attend follow-ups, and consider cognitive therapy if needed.
Conclusion
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Looking for Best Hospitals for Epilepsy Surgery
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.