Evaluation for Epilepsy Surgery
Your doctor may recommend an evaluation for surgery if medicines and a ketogenic diet do not control your seizures.
You will be seen by an epileptologist at the Comprehensive Epilepsy Center of Dayton for a thorough evaluation of your seizures. An epileptologost is a neurologist with expertise in epilepsy. If you are a potential candidate for surgery, we proceed with testing. We use a four-step process to plan the surgery and help to make sure it will provide the safest and best outcome.
Step 1: Non-Invasive Studies and Team Evaluation
You and your epileptologist talk about your seizure history and the treatments you’ve tried. If surgery is an option, your doctor may order tests to better understand your seizures, including where they begin in the brain.
Testing may include:
- EEG (electroencephalogram)
- Video EEG monitoring
- Brain MRI
- Functional MRI (fMRI)
- Blood flow and metabolism imaging (PET/CT or SPECT scan)
- Neuropsychological testing
After testing is complete, your epileptologist will discuss your case with the epilepsy team. The team will review your condition at a multidisciplinary conference. All members of the epilepsy team review the test results and discuss if any type of surgery is a good option. They may also recommend further testing.
If the team decides that you are a good candidate for surgery, you will meet with an epilepsy surgeon to talk about the type of surgical options available, and any further testing that is needed.
Step 2: Wada Test
The Wada test is a specialized method that uses angiogram and anesthesia medicines to map speech and memory to help plan surgery. Most patients being evaluated for epilepsy surgery will undergo this test.
Step 3: Intracranial Monitoring
If more information is needed to pinpoint where your seizures begin, intracranial monitoring may be used. The neurosurgeon places very thin, soft electrodes on the surface of, or within, the brain in the operating room while the patient is under anesthesia. The patient is then monitored in the hospital.
To provide more precise information about where seizures begin, functional testing may also be performed at this time to determine if seizures arise from critical brain areas.
Step 4: Deciding On Surgery
Once you have completed all the testing and your epileptologist finds the brain region causing your seizures, your epileptologist will again present your case to the multidisciplinary epilepsy team. They will review all the information and make recommendations regarding what procedure is best for you.
Your epileptologist will discuss all the testing and recommendations with you and create a treatment plan. The benefits and risks of surgery and other treatment options will be discussed.
You and your epileptologist will make a decision together about which surgical treatment is best for you. You will then be referred to the neurosurgeon. The final decision regarding surgery is yours.
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