Epilepsy affects over 95, 000 Ontarians (80, 000 adults; 15, 000 children) and approximately 30% of those are deemed to be medically refractory, that is, they do not respond to treatment with two or more appropriately chosen anti-seizure medication within a reasonable period of time (Ontario Brain Institute, 2015)
Any patient (regardless of age) who fulfills the above criteria for medically-refractory epilepsy is considered a surgical candidate and is eligible for assessment. These patients should be referred to a District Epilepsy Center (DEC) or a Regional Epilepsy Surgery Centre (RESC) in order to assess surgical candidacy. Recent epilepsy service investments by the Ministry of Health and Long-Term Care have increased access to treatment to improve outcomes for this patient cohort (Provincial Guidelines for Epilepsy Surgery Referrals in Ontario, CCSO, 2016).
There are three Regional Epilepsy Centers in Ontario University Health Network (Toronto Western Hospital), London Health Sciences Centre and the Hospital for Sick Children. These are facilities that houses a comprehensive epilepsy program that provides all epilepsy clinical services including the assessment by an epileptologist, an Epilepsy Monitoring Unit, neuropsychological services and the ability to perform intracranial monitoring and epilepsy surgery
Although these facilities are available to perform epilepsy surgery, this service remains largely underutilized. The decision to have epilepsy surgery is obviously one that should be given careful consideration but it is also true that many are not aware that surgery is a treatment option or are plagued with myths and misconceptions about risks vs benefits. Others may not even be aware of the existence of these Regional Epilepsy Centres and the work they do.
If you have being told you have medically refractory epilepsy and have tried many anti-seizure medications with no success, speak to your doctor about referring you to a comprehensive epilepsy program where you can be assessed for surgical candidacy.
If you are told you are a surgical candidate but you have questions, Epilepsy Toronto is here to assist you with the decision making process. We will provide you with information on the various surgical options, help you weigh risks vs benefits, guide you into decision making practices and connect you with others who have had surgery so you can learn from their experiences.
How does surgery work?
Which patients are candidates for epilepsy surgery?
It is important to stress that not all patients with medically refractory epilepsy can be helped with surgery. The best surgical candidates have seizures arising from a single location and from an area of the brain that is relatively silent meaning that the seizure focus can be safely and completely removed.
Which patients cannot be helped by epilepsy surgery?
What investigations are required for surgery?
What is the neuropsychological assessment for surgery?
How is the surgery performed?
What is the “callosotomy” surgery for epilepsy?
What are the risks and benefits of epilepsy surgery?
In patients with an identified focal seizure focus, the success rate of surgery is up to 80 per cent. This is the number of patients that will be seizure free for five years after surgery with some patients experiencing occasional auras and some still taking anticonvulsant medication. For patients with generalized seizures without a focal onset the results are still not as good. These patients may nevertheless obtain a worthwhile improvement with an operation.
Have there been recent advances in epilepsy surgery?
These advances together with improvements in surgical techniques have increased the safety and efficacy of operations for the treatment of epilepsy.