Physician Specialist Glossary

Even though medicine is the most common approach to treating epilepsy, it does not always work. In almost one-third of people with epilepsy, medicine cannot control their seizures adequately (or at all, in some cases). This number is even higher in people with focal epilepsy. Surgery can greatly improve the lives of some people who have epilepsy.

You may be a good candidate for surgery if your seizures:

• Occur often enough to severely disrupt your life.
• Tend to result in injury or harm (for instance, if seizures cause frequent falls).
• Change or alter your consciousness.
• Are not controlled well with medicine, or you cannot tolerate the side effects of the medicines.

Having frequent or severe seizures often restricts you from driving, doing certain kinds of work, and other activities. Medicine may fail to control these seizures. Or medicine may cause side effects severe enough to disrupt your lifestyle.

Surgery is not an "if all else fails" approach to treating epilepsy. It often may be a better choice than trying each and every medicine. For adults with temporal lobe epilepsy, for instance, surgery may be considered if two different first-line medicines are tried and neither controls the seizures adequately. For certain types of childhood epilepsy-disorders that children cannot outgrow and that do not respond to medicine-having surgery at the youngest possible age may offer the greatest benefit for the child. The younger brain is more adaptable and recovers better after surgery.

Epilepsy surgery removes an area of abnormal tissue in the brain, such as a tumor or scar tissue, or the specific area of brain tissue where seizures begin. Before surgery, you may have several tests (including an electroencephalogram [EEG], magnetic resonance imaging [MRI], and video monitoring) to find exactly where seizures begin in the brain. After the area of abnormal tissue where your seizures begin has been located, doctors can decide whether or not it can be removed safely.

Surgery is usually done in a hospital that is associated with an epilepsy center. The surgery usually takes a few hours, and you have to stay in the hospital for a few days afterward. It may be several months or more before you feel fully back to normal.

Surgery choices

The type of epilepsy surgery depends on the location in the brain in which seizures start.

The most common surgery is anterior temporal lobectomy, which is the removal of part of one of the brain's temporal lobes. For many people with temporal lobe epilepsy, this surgery offers a very good chance of becoming seizure-free.

Some types of surgery are usually only done on children.

• Corpus callosotomy helps some children who have Lennox-Gastaut syndrome by reducing falls that happen during seizures. These can happen often and often cause injury to the child.
• Hemispherectomy during the first few years of life may benefit children with other uncommon, severe forms of epilepsy (such as Rasmussen syndrome or Sturge-Weber disease).

What to think about

Surgery can be very effective for some people with epilepsy. But surgery is not an option for everyone. If you or your child has a type of epilepsy that might improve with surgical treatment, you may want to think about some of these issues:

• Surgery is not a last resort. It may be considered after unsuccessfully trying two medicines.
• Early surgery for some forms of childhood epilepsy may end seizures and prevent or reverse developmental delays. Children make good surgical candidates. They tend to recover quickly with fewer problems afterward.
• People who have temporal lobe epilepsy and whose seizures do not get better with medicines may be good candidates for surgery.
• Surgery is not always a cure for epilepsy. Some people never have seizures again after surgery. But for many others, surgery only reduces seizure frequency or severity.
• You need to be healthy to have the surgery and to benefit from it. People with severe illnesses, psychiatric disorders, or neurological problems other than epilepsy may need evaluations from more specialists to see if they are good candidates for epilepsy surgery.
• Epilepsy surgery involves removing part of your brain. It can affect your brain function, although the effects may be less bothersome than those caused by the epilepsy itself. Problems after surgery can be mild to severe-such as less energy, visual defects, language and memory problems, and weakness or partial paralysis on one side of the body-and may be temporary or permanent.
• Brain surgery is an expensive way to treat epilepsy and carries with it many risks. Even if medicine does not prevent your seizures, surgery may not be recommended if you only have seizures once in a while or do not have severe seizures.

What is Hirschsprung's disease?

Hirschsprung's disease is a birth defect that affects the nerve cells in the large intestine. These nerve cells control the muscles that normally push food and waste through the large intestine.

But in babies who have Hirschsprung's disease, the muscles in the wall of the large intestine don't relax, which prevents stool from passing. This can lead to trapped stool, infection, pain and swelling, and bowel problems.

Most of the time, the disease is found soon after birth in about 1 out of every 5,000 newborns. It is most common in male babies.¹

In rare cases, the disease can be life-threatening.

What causes Hirschsprung's disease?

Doctors don't know what causes the disease, but it tends to run in families. It may also be linked to other medical problems, such as Down syndrome and congenital heart disease.

What are the symptoms?

Symptoms include a swollen belly and problems passing stool. Newborns with the disease may not pass their first stool until at least 48 hours after birth.

Other symptoms depend on a child’s age, but can include vomiting, having a poor appetite, refusing to eat, and not growing or gaining weight.

How is Hirschsprung's disease diagnosed?

Most children are diagnosed with Hirschsprung’s disease during their first year. A doctor may think that a child has the disease based on the child's symptoms and the results of a physical exam.

Other tests may be done to confirm the diagnosis, such as:

• A tissue sample from the rectum (biopsy).
• An abdominal X-ray.
• An X-ray of the large intestine (barium enema).

If there is a delay in diagnosing Hirschsprung’s disease, the child could end up with serious, life-threatening complications.

How is it treated?

Children with Hirschsprung’s disease need surgery to remove the diseased part of the large intestine. Surgery is often done within the first days or month of life, soon after the disease is found. Children with Hirschsprung’s disease need one or two surgeries.

Long-term (chronic) problems with stomachaches and bowel problems are common after surgery. But most of the time, these problems are not severe. Depending on the problem, there are a number of treatment options. These include medicine, behavior modification, biofeedback, cognitive-behavioral therapy, and more surgery.

In a few cases, emergency surgery may be needed if a dangerous problem such as serious swelling of the small and large intestines (enterocolitis) occurs.

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