Epilepsy Surgery: A Safe and Effective Treatment Method When in the Hands of Experts

For more information on epilepsy surgery, please contact the Cleveland Clinic Epilepsy Center at 216.445.0601 or visit us online at clevelandclinic.org/epilepsy.

For patients diagnosed with epilepsy, medical management is the first line of treatment. However, some patients learn that their epilepsy is medically intractable, and their continued seizures can be damaging to their safety, development and quality of life. When patients fail to respond to two or more medications, epilepsy surgery can be a highly effective treatment option. These patients should be referred to a center specializing in the pre-operative evaluation and surgical treatment of these patients, such as the Cleveland Clinic Epilepsy Center.

Multidisciplinary management and state-of-the-art monitoring

Cleveland Clinic's world-renowned team of experts collaborates to determine which patients are eligible for surgery. This highly skilled team includes:

epileptologists,
neurosurgeons,
neuropsychologists,
technologists and
social workers.

Epilepsy surgery typically involves the removal of the region of the brain responsible for the abnormal electrical signals that cause seizures (the epileptogenic zone). Cleveland Clinic's surgical evaluation begins with patient monitoring in their state-of-the-art 10-bed adult epilepsy monitoring unit or eight-bed dedicated pediatric epilepsy monitoring unit, both of which run 24/7 and feature all-digital video EEG equipment.

Other imaging modalities used to precisely locate the epileptogenic zone include:

high-resolution MRI,
functional MRI (fMRI),
magnetic resonance spectroscopy (MRS),
ictal single-photon-emission computed tomography (SPECT),
positron emission tomography (PET) and
diffusion tensor imaging (DTI).

Cleveland Clinic now also offers magnetoencephalography (MEG), the most advanced way to noninvasively measure electrical brain activity. This sophisticated imaging modality is offered by only a handful of centers in the country.

A variety of surgical techniques with excellent outcomes

Once the epileptogenic zone is identified and patients are determined to be candidates for surgery, the Cleveland Clinic Epilepsy Center team determines the best resective approach, including

extra-temporal surgery,
hemispherectomy,
lesionectomy or
temporal lobectomy.

For patients where a focal onset within the brain cannot be identified, surgical options are still available, including brain stimulation and disconnection of the two hemispheres via corpus callostomy to reduce the severity of the seizures. About 300 adult and pediatric patients receive epilepsy surgery in 2008 at Cleveland Clinic, which has been performing the surgery for the past three decades.

Cleveland Clinic's experienced staff, modern diagnostic modalities, rigorous selection processes and well-honed surgical techniques are reflected in their exceptionally favorable outcomes. Two years after surgery, 75 percent of patients who underwent temporal lobectomy were completely seizure-free, compared with the national average of 72 percent. Ten years post-op, 68 percent of Cleveland Clinic patients remained seizure-free, compared with the reported national average of 51 percent. *

* National seizure-free rates represent a weighted average of recent studies conducted in the United States and published in Epilepsia, JAMA: the Journal of the American Medical Association, Military Medicine and Neurology.