Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Some of the risks associated with epilepsy surgery are
related to the presurgical evaluation. Some of the tests performed require the
use of contrast
material that might result in severe allergic reactions. Implanting electrodes
in the brain or placing electrodes on the surface of the brain for continuous
monitoring requires surgical procedures that are not very complicated but may be
associated with bleeding or infections.
Many tests, as well as the different surgical procedures, require the use of
heavy sedation or general anesthesia. General anesthesia has a very small risk
of death.
There are several risks inherent to the surgery, for example, bleeding inside
the brain. Bleeding inside the brain might result in additional brain damage,
besides; the accumulation of blood might increase the pressure inside the
cranium resulting in severe complications, including death. Also the operation
may be complicated by infections that can result in meningitis. A later
complication of these events could be the development of hydrocephalus, which
may require another surgical procedure.
As described before, resective surgery implies the removal of a piece of the
brain that in some instances could be as much as the whole hemisphere. This
resective surgery may aggravate prior functional deficits or may result in new
ones. These complications may occur even after very careful evaluation.
The
range of complications varies with the extent of the surgery and the area
removed. For example:
operations near the motor areas might result in paralysis
or weakness in the arms or legs, or loss of fine motor coordination in the
hands;
operations near the language areas might result in language disorders;
operations near the cortical visual areas might result in visual deficits.
In the particular case of the callosotomy, since there is some degree of
disconnection between the right and the left side of the brain, besides the
complications already mentioned, some annoying subtle deficiencies may be
experienced. For example, some patients may be able to identify, by visual
recognition, objects presented to one side of the brain, but might not be able
to name them because the memory of the name is in the other side of the brain.
In general there are fewer complications with callosotomies than with resective
surgery.
Yet, as in the case with all surgeries, there is always
the risk of failure. In the case of epilepsy surgery this means recurrence of the epileptic seizures
after the operation. Depending upon the type of pre-existing lesion, the failure
rate may be as high as 50%. However, even in these cases, the seizures may be
easily controlled with medications after the surgery.
In general there are very few complications observed after surgery.
Approximately 3% of children who have had epilepsy surgery experience
complications, and less than 1 % have neurological complications. Mortality
(death) is very rare.
As previously mentioned, there is plasticity in the
brain of young children, mostly up to the age of 7 to 9 years. The plasticity
helps in the recovery of deficits that can be the result of surgery. For
example, for children in whom the language areas were affected by the surgery
there is remarkable recovery of language functions. Therefore, young children
with intractable seizures who are
candidates for surgery are much better off when the surgery is done sooner than
later.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Genetic disease is a disorder or condition caused by abnormalities in a person's genome. Types of genetic inheritance include single inheritance (for example, cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis), multifactoral inheritance, chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Febrile seizures, or convulsions caused by fever in small children or infants can be frightening, however, in general are harmless. Febrile seizures is not epilepsy. It is estimated that one in every 25 children will have at least one febrile seizure. It is important to know what to do to help your child if he/she has a febrile seizure.
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