For epilepsy patients who cannot control their seizures through medications, or for those who cannot tolerate medications, surgery may be indicated. The University of Michigan Epilepsy Surgery Program, part of a collaborative partnership including the Department of Neurosurgery and the Department of Neurology, has a national reputation for excellence in patient care, treatment and research. Our team has extensive experience in epilepsy surgery, performing 70 to 100 procedures per year. Our goal is to work together to provide hope for those with epilepsy.
A multidisciplinary review of each patient involving neurology, neuropsychology, social work, speech and language pathology, radiology and neurosurgery is conducted in order to determine which surgery, if any, would be beneficial. Each patient under consideration for surgery participates in a thorough evaluation, including sophisticated testing and analysis, in the Comprehensive Epilepsy Program before surgery to control seizures is offered.
Vagus Nerve Stimulation
Vagus nerve stimulation is an FDA-approved treatment for treating seizures that are resistant to conventional epilepsy medications. The U-M Vagus Nerve Stimulation Program is staffed by adult and pediatric neurologists, a neurosurgeon and a clinical nurse specialist with vast experience in this therapy. VNS reduces the number and severity of seizures rather than curing them. The best candidates are typically patients who are not candidates for curative epilepsy surgeries. These include patients whose epilepsy is:
- Determined to be general epilepsy not originating from a specific area (focal point) of the brain
- Originating from a focal point that cannot be determined
- Coming from a focal point that is not safe to remove
VNS involves attaching an electrode to the vagus nerve in the neck, which is connected by a lead to a small stimulator placed under the skin in the chest. The stimulator provides a light electrical signal on and off throughout the day. This stimulation reduces the seizures’ ability to spread and typically results in a substantial improvement in seizure frequency and severity. The surgery is done under general anesthetic on an outpatient basis. VNS is used for the treatment of a wide variety of epilepsies, has low risks and minimal side effects.
Other Surgical Treatments for Epilepsy
For patients whose seizures are coming from a specific area of the brain, an option may be to remove that area, or epileptic focus, surgically. Before surgery is done, our neurosurgeons may choose to implant intracranial electrodes (grids) that allow us to precisely determine what area of the brain seizures are originating from and if it is safe to remove that area.
One of the most common procedures performed at U-M for removing epileptic foci is a temporal lobectomy. During this open surgery, our skilled neurosurgeons remove a portion of the temporal lobe of the brain. The temporal lobe contains the hippocampus, which is the source of epilepsy in some patients. This surgery typically is well-tolerated and requires a brief hospital stay. Temporal lobectomy often results in a cure or significant improvement, with research showing 60 percent to 70 percent of patients are free of seizures that impair consciousness or cause abnormal movements after the surgery. Other surgical options may include neocortical resections in any lobe of the brain, and other specialized procedures that may be needed to stop seizures.
At U-M, our Epilepsy Surgery Program has a national reputation for excellence in both surgery and research, including studying brain cells to try and better understand how epilepsy occurs. U-M is also currently participating in a national clinical trial to learn more about the genetic factors that play a role in epilepsy.