Epilepsy - Surgery

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Candidates. Candidates for this surgery usually have a history of seizures. Anti-epileptic drugs have not helped them. Young children may be more difficult candidates because they often have injured areas outside the temporal lobes. Nevertheless, surgery can be very successful in many children, even if more than one area is involved.

Success Rates. New imaging techniques are dramatically improving the success rates of temporal lobe surgery. Studies have shown that many patients remain seizure-free after temporal lobectomy. In a 2006 study of nearly 400 patients, (one of the largest epilepsy surgery studies to date), researchers found that 81% of patients with intractable epilepsy became totally or nearly seizure-free 6 months following surgery. Ten years after surgery, 72% of these patients remained totally or nearly seizure-free. A small 2005 study of patients who had temporal lobectomy found that half were seizure-free 30 years after the surgery.

Patients may still need to take medications after surgery, even if seizures are very infrequent. Cure is not always possible, and some patients may still experience some seizures. Double vision is very common after the operation, but it is typically temporary and resolves within a few months.

Studies also suggest that temporal lobe surgery improves quality of life and can help relieve depression and anxiety. Other studies indicate that surgery may even prolong survival. Some experts theorize that surgery stabilizes parts of the brain that influence heart rate and may reduce the risk of sudden death, a rare complication of epilepsy.

Effects on Mental Functioning. Although surgery on the left temporal lobe does not impair intelligence to any significant degree, studies on the effects of mental functioning and behavior are unclear:

• One study reported that 10% of patients experienced significant decline in language abilities while another 9% reported significant improvement. In the study, about 16% reported improvement in nonverbal mental functions.
• In a study of children, surgery improved behavior in 31% of the patients and mental function in 25%. (Negative changes in personality, emotions, or behavior are uncommon following surgery.)
• A study of 50 children ages 3 - 7 reported that 66% of the children were seizure free within a year after surgery. Nearly all the children showed improvement in cognitive development, and a few children’s IQ scores improved by 15 points.