The treatment options for the epilepsy include:

• Medication
  Anti-convulsant or anti epileptic drugs are the most common treatment for epilepsy. If one medication is not successful in controlling seizures, the doctors switch the drugs or adjust the dosage. About two- thirds of people with epilepsy become free of seizures with prescribed medication.
• Surgery:
  If your doctors can determine that your seizures always begin in a single area of the brain, removing that part of the brain can stop them or make seizures easier to manage. Surgery can also treat conditions that cause seizures, such as brain tumour.
  The procedures included in this approach are:
  • Temporal lobe resection surgery:This surgery is performed more commonly. In this the anterior and the middle portion of the temporal lobe, which is most often responsible for causing seizures is resected or removed.
  • Functional Hemispherectomy: This is rare but most successful surgery which is performed in most of the widespread and fatal epilepsies. This surgery aims in removing almost entire half of the cortex (brain) to eliminate the seizures completely.
• Palliative: This approach is opted when there is no definite lesion identified. The aim for this procedure is to reduce the frequency and severity of the seizures by disrupting the nerve pathways that propagates the seizure.

Following procedures are performed in palliative treatment.

• Corpus callosotomy: It is surgical procedure performed to reduce the frequency and severity of mostly the generalised seizure or primary atonic (drop attacks) seizure by simply disrupting or cutting the fibres of the corpus callosum which serve a pathway for conduction of the seizure impulse between the two halves of the brain.
• Multiple subpialtransections: This surgical procedure is indicated when the centre of seizure is well localized but cannot be removed or resected as it is located in the vital area of the brain that is involved in speech production, memory and sensorimotor tasks. In such case, the surgeon cuts the nerve fibres in the outer layer of the brain and preserves the deeper fibres that control the vital neurologic function.
• Vagus nerve stimulation: It is a palliative procedure for the patient with partial or generalized seizures. During this procedure, the vagus nerve stimulator is implanted under the skin of the chest which electrically stimulates the vagus nerve periodically. These signals are then transmitted from the vagus nerve to part of brain expected to be involved in producing seizures resulting in subsequent decrease in frequency and severity of the seizures.

If you are having epilepsy seizures which are disabling and uncontrolled, despite of adequate trials of at least 2-3 antiepileptic medications, or if you are resistant to AED drug therapy and if the seizures are significantly affecting your life, then you can be considered for the epilepsy surgery.

The procedure is done under general anaesthesia and it usually takes 3-4 hours to complete.

Once the anaesthesia has taken effect and you are asleep, your head is fixed in a position and scalp will be prepared for the surgery. The surgeon then makes an incision on the scalp to expose the skull and a circular opening is drilled in the skull to expose the brain tissue.

Brain mapping is done using the intra-operative EEG monitoring and recording by stimulating the brain areas with the subdural electrodes. During mapping, the involved area is localized and with the help of operative microscope the surgeon resects and removes the area of the brain causing seizures.

All the structures are then sutured back and the bone flap is secured to skull with screws. Once this is done you are moved to Neuroscience Intensive Care Unit to monitor your vital signs.

You may experience headache and nausea after the surgery which can be controlled with medications. A stay of 3-4 days in the hospital is required after the surgery. Sutures are removed 7-10 days after the surgery. You can expect to return to the normal activities after 3-4 weeks. You may get fatigued very often which is common. Walking is encouraged while driving and other strenuous activities should be avoided for few months. You are recommended to stay on AEDs for up to an year after the surgery, the dose of which can be gradually tapered and eventually stopped.

The results of the surgery are very gratifying. Following the definitive cure surgery, one can expect complete elimination of the seizure while the palliative treatment results in decrease in frequency and length of the seizures ultimately leading to near normal and healthy life.

A stay of 3-4 days at the hospital followed by 1-2 week stay in India is required to recover well and fly back after the epilepsy surgery in India.