Page 480 - ILAE_Lectures_2015

Chapter 52

Counselling for epilepsy surgery

SUSAN USISKIN MBE

National Hospital for Neurology and Neurosurgery, Queen Square, London, and Epilepsy
Society, Chalfont St Peter, Buckinghamshire
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Surgery is considered for people with epilepsy whose seizures are not well controlled by
antiepileptic medication, or who continue to experience unacceptable side effects for whom
the possibility of surgery has been raised.

A number of different factors need to be taken into consideration before it is possible to say
whether or not a patient may benefit from surgical treatment. In the majority of cases, surgery
will normally be considered if:

 Antiepileptic drug (AED) treatment has been tried using a number of different
medications but these have proved unsuitable, or unsuccessful in stopping the patient’s
seizures

 The epilepsy can be seen to be arising from one localised area of the brain
 The part of the brain causing seizures is accessible to the surgeon and can be removed

without damaging other parts of the brain or brain functions, such as speech, sight,
movement or hearing
 The patient has no other medical problems which would make them unsuitable for this
type of surgery
 The patient is thought to have a good chance of becoming seizure free following the
surgery or having a worthwhile improvement in severity, frequency or both.

Referrals

At the National Hospital for Neurology and Neurosurgery, a dedicated epilepsy surgical
counselling service exists in which all patients are seen prior to surgery. The purpose of this
is to enable the patient and their family to discuss any concerns they may have and to clear
up areas of misunderstanding prior to making the final decision as to whether or not to go
ahead with an operation. The surgical counsellor is seen towards the end of the pre-operative
investigations and referral may come from either the patient’s consultant neurologist or
neurosurgeon.

The counsellor has the report of the consultant neurologist or neurosurgeon to hand and will
be able to advise about the patient’s individual case. At this time, it is important to find out
more about the patient’s social support and family circumstances which vary from case to
case. The planning of professional support in advance of the operation is important in patients
who do not have this support at home.

Expectations of surgery

Expectations of surgery vary a great deal. This is an issue that needs to be discussed in detail
with individual patients in order to find out how seizures have impacted on their lives so far
and what they may reasonably expect from themselves and others if the operation is
successful. Common areas for misunderstanding include: