Medically Intractable Epilepsy
If medications do not successfully control seizures, they are called “intractable.” We believe that anyone with epilepsy who is still having seizures despite trying several medications at reasonable doses is intractable. For these individuals, we aggressively search for the area in the brain where seizures originate (the focal point). If the focal point can be identified, then it may be treated surgically to eliminate seizures.
While neurosurgery may seem a radical step for the treatment of epilepsy, it is actually a rather safe and well-tolerated treatment when performed by experienced teams. Although surgery has risks, studies have consistently shown that the benefits outweigh the risks by reducing the number of or completely curing seizures.
Eliminating seizures helps:
- Stop the progressive cognitive decline associated with frequent seizures
- Enable patients the freedom to drive again
- Reduce or eliminate the need for anti-seizure medications
Some patients with seizures that are not well-controlled by medications are not good candidates for neurosurgery. In these cases, an alternative, less invasive procedure called vagus nerve stimulation may be recommended.
The Northwestern Comprehensive Epilepsy Center team is staffed by experienced board-certified physicians who are all fellowship-trained in epilepsy and epilepsy surgery.
Candidates for Epilepsy Surgery
A person is considered to be a potential candidate for surgery if his or her seizures cannot be controlled by medications:
- Two first-line seizure medicines fail to control seizures
- A two-drug combination of seizure medicines fail to control seizures
The best candidates for epilepsy surgery are those who do not respond to medication and who also have seizures that originate from a single focal area of the brain. Conditions that often fall into this category include:
- Mesial temporal sclerosis (hippocampal sclerosis)—this is the most common epilepsy disorder that is surgically curable and is the disorder seen in 75 percent of patients undergoing epilepsy surgery
- Cortical dysplasia—small congenital malformations of the cortex that cause seizures
- Other congenital anomalies of brain development
- Cavernous angioma—benign vascular tumors that are prone to cause seizures
- Other brain tumors
- Brain trauma
Surgery has the highest chance of success if the following two conditions are present:
- The location of seizure onset is consistently and repeatedly from the same portion of the brain, such as the frontal or temporal lobes.
- The region of the brain can be safely removed without creating significant disability.
Note: If the studies are inconclusive regarding the exact location of seizure onset, implanted electrodes may be necessary to more closely localize the seizure focus. Subdural electrodes may be placed on the brain (subdural grids) or into the brain (depth electrodes) to more precisely record the seizure onset.