About Epilepsy Surgery

Who is a candidate for surgery?

Many patients may be candidates for one of the surgical interventions we offer. The best way to know if you are a candidate is to come in for a clinic appointment to discuss your individual case. A pre-surgical evaluation can help determine the type of epilepsy you have and what options may be offered to you. Patients who often undergo pre-surgical evaluation include:

· Patients whose seizures are not satisfactorily controlled by medication

· Patients with drop (atonic) attacks

· Patients with partial-onset (focal) seizures whether or not associated with a lesion on MRI

· Patients for whom medication side effects are intolerable

What kind of surgeries and treatments does UCSF offer for epilepsy?

We tailor our approach to each patient, and may be able to offer one of the following options:

· Anterior temporal Lobectomy
Anterior temporal lobectomy is one of the most common surgical procedures for epilepsy, and may be offered to those patients who seizures originate in the temporal lobe of the brain. In this surgery, the area of the temporal lobe on the side of the brain determined to be causing your seizures is removed surgically. The temporal lobe is used in memory, language, and emotion; thorough pre-surgical evaluation, diagnostic testing, and imaging help ensure the protection of these processes. The procedure can be done either “awake” or “asleep”, depending on the patient’s individual surgical plan. All patients will receive anesthesia, however for those undergoing an “awake” procedure we will lighten the sedation during part of your surgery in order to perform some language and memory testing which can provide additional information to allow our surgeon to perform a precise resection. You will not feel any discomfort and this type of procedure simply allows us provide surgeries with the greatest amount of information and precision. Resective surgery for epilepsy is tailored to each individual patient, and with resection some patients may require a two-step process that includes one to two weeks of intracranial EEG monitoring before any part of the brain is removed.

· Resection of epileptogenic region outside of the anterior temporal lobe–-neocortical epilepsy surgery
When an area of brain tissue outside of the anterior temporal lobe is identified as the source of a patient’s seizures, it may be possible to remove this area surgically. As with temporal lobe surgery we will do an extensive evaluation not only to locate the area of brain involved in seizure generation, but also, to delineate the function of the brain regions that are close to(or overlap) the target area and may be affected by surgical resection. Once we understand how the where the seizure onset zone is situated in regards to areas of the brain function such as speech or hand movements, we can advise patients as to whether surgery is possible and what the likely risks and benefits should be. Many patients are able to undergo this type of surgery at UCSF and Dr. Knowlton is actively pursuing research in this area. Please see the links below on the NEST trial, and take some time to complete the STRIVE survey if you are a candidate for this type of surgery.

· Visualase Thermal Laser Ablation
This is one of the newest and most exciting options for surgical treatment of epilepsy.

Read more about this exciting treatment.

· Vagus Nerve Stimulation (VNS) Therapy
VNS therapy is quite different from traditional resective surgery (surgery where brain tissue is removed). In VNS therapy a small generator similar to a pacemaker with a single flexible wire is implanted in a patients’ chest wall. The flexible wire, or lead as it is often called, send mild stimulation to the left vagus nerve. The vagus nerve then delivers these periodic stimulations to the brain in order to help prevent the electrical abnormalities which may cause seizures. VNS therapy is approved for use as an adjunctive therapy in adult patients with partial onset seizures which are not controlled by medications. Additionally, some patients who are not candidates for traditional resective surgeries may be eligible for VNS implantation.

· NeuroPace RNS
UCSF is one of the first centers on the west coast to provide this novel surgical therapy to patients.

Read more about this exciting treatment.