Epileptic Seizures May Dissipate After Brain Surgery

June 22, 2009 — -- Emma Kon, 25, made news in the United Kingdom after doctors performed multiple surgeries to remove seven parts of her brain in an effort to treat an epileptic condition which crippled her with up to 100 seizures each day.

Now, about nine months after her treatments, Kon told the U.K.'s Daily Mail that she has had no seizures and is feeling well.

While epilepsy experts say that complications from brain surgery usually occur immediately after the operation and that reduced seizure activity is a good sign that a person is in recovery, side effects of drastic brain surgery can arise unexpectedly.

And epilepsy, a disease that affects about three million people in the United States, can be a wily disease that may return without warning in a different part of the brain.

Removing Brain Bits

Brain surgery can be a common and successful way to treat some forms of epilepsy.

"Some epilepsies are amenable to surgery and some are not," said Dr. Emad Eskandar, director of functional neurosurgery at Massachusetts General Hospital in Boston. "If we can pinpoint the source of epilepsy to one or two foci in a relatively safe area of the brain, there is a good chance of curing or significantly reducing the number of seizures with surgery."

Eskandar said the success rate of surgery to remove a portion of the brain -- and about half of patients with epilepsy have problem areas in the temporal lobes, in the center of the brain -- is about 80 percent, and patients show a reduced rate of seizures.

And removing even a significant chunk of nonessential brain tissue -- those parts responsible for bodily functions, which we could not live without -- may have no outward effect on how the patient thinks or behaves post-surgery.

"Are they neurologically OK? Yes," Eskandar said. "If a part of the brain is the seizure's focus, that means it's not working properly anyway. Either the person has a mild deficit that they have already adapted to or over time the function of that area has moved to another part of the brain."

Epilepsy Surgery Leaves Some With Memory Gaps

Despite the relative success of surgery for epilepsy, patients are sometimes left with distinct holes in their thinking, reasoning or memory post-surgery.

Jim Barron, 64, from Sharon, Mass., had surgery to remove a brain tumor that was causing seizures during which he would smell bad odors, see colors more intensely and experience deja vu. After being treated at the National Institutes of Health in 1964, Barron said he no longer had seizures unless he was over-stimulated by illness or intense emotions, such as his divorce.

"It really solved the problem," said Barron, and reported that he had only had five seizures in the past 30 years, compared to up to 30 per day at his worst, pre-surgery.

But the operation affected parts of his memory, especially his short-term memory.

"Everybody thinks you're perfectly OK and then you're caught on a cliff," Barron said. "I come to a point in my thoughts and stop because there's nothing there."

Removing Discrete Brain Areas Is Unusual

It is unclear whether Kon had surgery to remove an area of brain with seven regions in it, such as a hippocampus, amygdala, areas responsible for memory or speech, or if seven distinct regions were removed, the latter being rare.

"It's unusual for us to go after multifocal epilepsy with [surgery]," said Dr. Aviva Abosch, director of epilepsy surgery at the University of Minnesota Medical Center in Minneapolis.

Abosch suggested that doctors may have identified several problem areas interspersed with essential brain areas in Kon's left temporal lobe, a region that contains areas for speech, memory and emotional processing, and where Kon's seizures were shown to originate from. Kon may have had several chunks from that area removed, leaving the essential areas intact.

But, depending on how much of the brain is affected, there is concern that a patient will develop seizures again in other areas.

"Sometimes, after general anesthetic, people have this honeymoon period where seizures go away. But then they come back," Abosch said.

Patients with these types of recurrences in epilepsy remain a mystery to their doctors, as Carlton Zeigler, 47, said he remains to his doctors.

Seizures Can Return in Time

Zeigler had adolescent onset epilepsy and began treatment with medications, which did not work. He has since had two brain surgeries and one surgery to implant a vagus nerve stimulator to disrupt oncoming seizures. Following each treatment, his seizures become less frequent. But eventually, they return in force.

His surgeries, which were done to remove potential seizure-inducing regions in his right temporal lobe, left Zeigler with memory loss and less emotional control.

"These three surgeries have not managed to control my seizures," Zeigler said. "At this point, my case has [my doctors] completely puzzled. We're doing more testing."