Epilepsy is a chronic neurological condition characterized by recurrent, unprovoked seizures. Seizures occur when abnormal electrical activity in the brain disrupts normal neurological function. Epilepsy affects approximately 3.4 million people in the United States and can develop at any age.
While most patients with epilepsy achieve good seizure control with anti seizure medications, roughly one third continue to have seizures despite trying multiple medications. This is known as drug resistant or refractory epilepsy, and it is the primary reason patients are referred for neurosurgical evaluation.
Types of Seizures
Seizures vary widely in their appearance depending on which part of the brain is involved. Understanding the seizure type is essential for determining the best treatment approach.
- Focal seizures begin in one area of the brain and may cause twitching, sensory changes, or altered awareness
- Generalized seizures affect both sides of the brain simultaneously and include tonic clonic (grand mal) seizures
- Absence seizures cause brief lapses in awareness, often mistaken for daydreaming
- Temporal lobe seizures are the most common type in adults and may involve unusual sensations, staring, and repetitive movements
- Some seizures produce warning signs (auras) such as unusual smells, deja vu, or a rising sensation in the stomach
- Seizure clusters or prolonged seizures (status epilepticus) are medical emergencies
Neurosurgical Options
Neurosurgical evaluation is appropriate for patients whose seizures are not controlled by two or more anti seizure medications. A comprehensive epilepsy workup including video EEG monitoring, brain MRI, and sometimes PET or SPECT imaging helps determine whether a surgically treatable focus can be identified. Dr. Waldron offers vagal nerve stimulation (VNS), an implantable device that delivers regular electrical pulses to the vagus nerve to reduce seizure frequency and severity.