Epilepsy Surgery Types: Treatment, Success Rate, & Cost in India

Surgery for epilepsy involves excising a part of the brain where seizures are most common. The best candidates for epilepsy surgery are those whose seizures consistently happen in one area of the brain. If at least two anti-seizure medications have failed to reduce seizures, it may be a possibility. With epilepsy surgery, seizures can be stopped, or their intensity is reduced; however, the first course of treatment is not surgery. To determine whether epilepsy surgery is a viable option and what kind of surgery to perform, you may require a number of tests prior to surgery. 

When medication is unable to manage seizures, drug-resistant epilepsy or medically refractory epilepsy surgery becomes the option. Additionally, this surgery is performed to reduce the number of deaths caused by seizures, the amount of anti-seizure drugs used, and the potential side effects of those drugs.

Types of Epilepsy Surgery

Epilepsy surgery encompasses various procedures aimed at treating epilepsy by addressing the underlying causes of seizures. Here are the types of surgery used for epilepsy – 

• Resection Surgery

This common procedure involves removing a specific area of the brain where seizures originate. It is often performed on the temporal lobes and can significantly reduce seizure frequency while minimising the risk of permanent brain damage.

• Disconnection Surgery

In this type of surgery, the surgeon disconnects parts of the brain, preventing the spread of seizures. It can involve cutting connections between brain hemispheres or nerve fibres in the outer brain layers.

• Laser Interstitial Thermal Therapy (LITT)

Also known as laser ablation surgery, LITT uses a laser to precisely target and destroy the brain area causing seizures. It is minimally invasive and allows for pinpoint accuracy without the need to open the skull.

• Corpus Callosotomy

Corpus callosotomy involves cutting the corpus callosum, the bundle of nerve fibres connecting the brain’s two hemispheres. This prevents seizures from spreading between hemispheres, reducing the severity of generalised tonic-clonic and atonic seizures. It is reserved for patients with severe, uncontrolled epilepsy affecting both brain sides.

• Hemispherectomy

Hemispherectomy is a surgical procedure where one cerebral hemisphere is removed or disconnected from the rest of the brain. It is used to treat severe, uncontrolled epilepsy in children when seizures originate from one side of the brain. Over 80% of patients experience significant seizure reduction after this surgery.

• Multiple Subpial Transections (MST)

In MST, a series of shallow cuts are made in the brain’s grey matter to interrupt the spread of seizure activity without causing permanent impairment of important functions. It is used when seizures originate in areas that cannot be safely removed, such as those responsible for speech or movement. MST may be combined with resective surgery.

Factors such as the location of seizures in the brain, the individual’s overall health, and the potential risks involved are crucial in determining the most suitable surgical approach. It is essential for patients to have a thorough discussion with their healthcare team to understand the implications, potential outcomes, and recovery process associated with each type of epilepsy surgery before making a decision.

What is the Success Rate of Surgery?

The success rate of epilepsy surgery varies depending on the type of procedure and the patient’s individual case. For temporal lobe epilepsy, studies have reported seizure-free success rates around 60-70% after surgery. Even at follow-ups longer than twenty years, researchers have reported that around 65 percent of people remain seizure-free. 70%t of patients who had temporal lobe surgery become seizure-free, with 50% remaining seizure-free after ten years. 

Laser ablation, a minimally invasive approach, has a “seizure freedom” rate of about 60% compared with 70% or 75% for similar cases treated with resection. For resection surgery or a hemispherectomy, between 50% and 85% of people may experience significant improvement in controlling seizures and, in some cases, become seizure-free. The success of epilepsy surgery depends on many factors, including the location of seizures in the brain and the safety of the procedure without affecting important brain functions. Overall, epilepsy surgery can be a highly effective treatment option for those with uncontrolled seizures, offering a significant chance of seizure freedom or reduction in seizure frequency.

What is the Cost of Epilepsy Surgery in India?

The cost of epilepsy surgery in India ranges between Rs. 2 lakh and Rs. 15 lakhs (USD 2500 to USD 18,000), covering evaluation and the surgical procedure itself. The variability in costs is due to the personalised nature of evaluations and surgeries required for each patient, making it essential to consider individual needs and treatment plans.

The cost of epilepsy surgery in India is influenced by several factors, including – 

• Type of surgery – Different surgical procedures have varying costs. For example, resective surgery, which involves removing a part of the brain causing seizures, may cost around Rs. 2.5 lakhs on average, while a hemispherectomy, which is more complex, can cost up to Rs. 15 lakhs.
• Hospital & facilities – The cost can vary depending on the hospital, its location, and the available facilities. Surgeries performed at top-tier hospitals in metro cities tend to be more expensive than smaller hospitals in tier-2 or tier-3 cities.
• Surgeon’s expertise – The cost may be higher if the surgery is performed by a certified and highly experienced neurosurgeon.
• Diagnostic tests – The cost of pre-operative tests like MRI, CT scans, and EEG can add to the overall expense.
• Duration of hospital stay – A longer hospital stay, often required for complex surgeries or in case of complications, can increase the total cost.
• Medications and post-operative care – The cost of anti-epileptic drugs, rehabilitation, and follow-up visits can also contribute to the overall expenses.
• Insurance coverage – If the patient has subscribed to a health insurance that covers epilepsy surgery, it can significantly reduce out-of-pocket expenses.

It is important to note that the cost of epilepsy surgery in India is still significantly lower compared to many other Western countries, making it an affordable option for patients seeking high-quality care.

Are There Any Risks Associated With Epilepsy Surgery?

Inadequate management after the epilepsy surgery can lead to several problems and health hazards, such as – 

• Infection
• Stroke
• Speech difficulties
• Motor skills impairment
• Developmental delays in kids
• Unexpected demise, an uncommon side effect of epilepsy
• Memory loss
• Sudden decline in cognitive abilities

The surgical site and procedure type have an impact on the risks. The medical staff describes the particular hazards associated with the operation and how to lower the chance of problems. Possible risks include – 

• Language and memory issues that may impair one’s capacity for language understanding and usage
• degradation of vision where the eye’s overlapping fields of vision
• Depression or other emotional disturbances that may impact interpersonal relationships
• A headache
• Heart Attack

Conclusion

Epilepsy surgery is important in managing refractory epilepsy – offering a potential pathway to significantly improve seizure control and quality of life for individuals who have not responded well to traditional treatments. Epilepsy surgery provides a chance for seizure freedom or a substantial reduction in seizure frequency, ultimately enhancing the overall well-being and functionality of patients.

Despite these risks, the benefits of epilepsy surgery, including the possibility of achieving seizure control and improving quality of life, prove it to be a valuable treatment option for individuals with drug-resistant epilepsy. It is always advisable to get immediate help from certified healthcare professionals at Omni Hospitals, which is backed by world-class facilities and cutting-edge infrastructure.