What really happens during epilepsy surgery? Do you have to be awake during surgery? When is epilepsy surgery a better treatment than medication?
These were some of the questions answered by UCI Health neurosurgeon Dr. Sumeet Vadera during a recent Reddit AMA (Ask Me Anything) session. Vadera, director of epilepsy surgery, was joined by neurologist Dr. Jack Lin, director of the UCI Health Comprehensive Epilepsy Program, who addressed whether a link exists between epilepsy and bipolar disorder.
The AMA format is a thread of online questions submitted by registered Reddit members and answered by the hosts, providing a forum for a wide variety of honest, earnest and thought-provoking questions not found in a typical media interview.
Epilepsy dominates the session
Questions about epilepsy dominated the session, ranging from the doctors’ opinions on the effectiveness of different types of treatments to the various causes of epilepsy to the correlation between epilepsy and other conditions such as autism, migraines and bipolar disorder.
Epilepsy surgery was the topic that generated the most inquiries, with members wanting to know details about how the procedure is performed, when it is appropriate and risks involved.
This happens to be one of Vadera’s favorite subjects, as he finds epilepsy surgery “especially exciting as I have seen amazing transformations and improvements in people’s lives after surgery.”
What really happens during epilepsy surgery
The doctors also had the opportunity to clarify some erroneous perceptions about epilepsy surgery.
“You don’t have to be awake for these surgeries. We do awake surgery but it is uncommon. We are removing parts of the brain that are abnormal and not functioning properly, we avoid taking out normal tissue. These surgeries are very safe, risks are extremely low, especially at high volume-centers such as ours. You should be able to walk and talk after surgery just as well as you did before; if you didn’t play the piano before surgery, it’s unlikely you will be able to do it after surgery.”
Surgery vs. medication
Several participants asked about when epilepsy surgery the right option.
“[P]atients that have failed a reasonable trial of medications should be evaluated for epilepsy surgery, there aren't any age cut-offs,” Vadera wrote.
“Depending on the type of seizures and the additional tests performed, surgery may first require diagnostic tests such as invasive electrode implantation (subdural grids and SEEG) or may go straight to a resection (temporal lobectomy, hemispherectomy, etc). When other options are not available, we discuss vagus nerve stimulation. For all these procedures, risks are low and the benefits far outweigh the risks, especially in patients that are candidates for resection. Temporal lobectomy for instance, has some of the best outcomes of any seizure surgery and risks are very low when done at a high-volume center.”