While most patients with epilepsy gain complete control of their seizures using one or two medications, there are treatments available for those who are refractory to medicine. Pre-surgical evaluation is carried out at the MUSC Comprehensive Epilepsy center using techniques such as continuous video EEG monitoring, high resolution magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). These and other tests are used answer the question, "where does the seizure come from in the brain?" From that answer, we can offer surgical intervention aimed at curing the patient of their seizures.
The most frequent site of origin of refractory seizures is a part of the brain called the temporal lobe. This area sitting just in front, and above, the ear is involved with memory processing, but in most patients with seizures, the temporal lobe has become scarred and is no longer serving a useful purpose. This area of scar may be removed in an operation termed anterior temporal lobectomy. This operation eliminates seizures in about 75% of patients and dramatically lessens them in another 20%. Other regions of the brain may be found to be the source of a patient's seizures and these areas may be removed if tests show surgery to be safe. Topectomy, lesionectomy, hemispherectomy and functional hemispherectomy are terms that describe removing a portion of the brain that is not useful to the patient, but is the source of the seizures.
When the seizures originate in areas of the brain that are still useful, disconnection operations may help stop the onset, or stop the spread, of seizures. These operations include multiple sub-pial transections (MSTs), corpus callosotomy and significantly reduce the number or severity of the patient's seizures. Finally, neuromodulation is a term that refers to using implanted devices to reduce the likelihood that an irritation in the brain will become a seizure. The vagal nerve stimulator (VNS) is one such device that is used at MUSC to decrease the number or the severity of a patient's seizures when a suitable resection is not possible.