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An estimated 3 million Americans suffer from some form of epilepsy. Even under the care of general neurologists or epileptologists, approximately 30 to 40 percent of patients with epilepsy do not attain adequate seizure control, thus making their seizures intractable. People with intractable seizures often need more intensive and comprehensive care than is available through their neurologist. The care, including epilepsy surgery, is available at the UMMC Comprehensive Epilepsy Center.
A person with epilepsy has had two or more unprovoked seizures, regardless of seizure type. There are many types of epilepsy, depending on age of onset, seizure type(s), EEG findings, family history, and neurological history, among other factors.
The first step in deciding whether someone should have epilepsy surgery is to make sure that the seizures are medically refractory, or uncontrollable with antiepileptic drugs. Most patients with difficult-to-control seizures have been treated with two or more drugs in separate trials and in various combinations, without any success. If the seizures are frequent, relatively short trials of medications can reveal the failure of medical therapy.
After a patient’s seizures are confirmed to be medically refractory, a series of pre-operative diagnostic tests are performed to identify the area of the brain from which the seizures arise and the areas that control vital functions such as language, memory, movement, and sensation. Doctors hope to find that the seizures arise from an area that is not vital for intellectual or other important functions.
Many potential surgical candidates select the risks and benefits of surgery over the disadvantage and medication burden which accompanies refractory seizures. Over the past three decades, important strides have been made in developing new technologies and surgical techniques that have made surgical intervention both safe and effective.
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