When a person's seizures cannot be adequately controlled by medications, doctors may recommend that he or she be evaluated for surgery. To decide if a person may benefit from surgery, doctors consider the type or types of seizures he or she has. They also take into account the brain region involved and how important that region is for everyday behavior.
Three broad categories of epilepsy can be treated successfully with surgery. These include:
- Focal seizures
- Seizures that begin as focal seizures before spreading to the rest of the brain
- Unilateral multifocal epilepsy with infantile hemiplegia (such as Rasmussen's encephalitis).
Doctors generally recommend surgery for epilepsy treatment only after people have tried two or three different medications without success, or if there is an identifiable brain lesion -- a damaged or dysfunctional area -- believed to cause the seizures.
(Click Epilepsy Surgery to read more.)
Studies have shown that in some cases, children may experience fewer seizures if they maintain a strict diet rich in fats and low in carbohydrates. This unusual diet, called the ketogenic diet, causes the body to break down fats instead of carbohydrates to survive. This condition is called ketosis.
One study of 150 children whose seizures were poorly controlled with medication found that about one fourth of the children had a 90 percent or better decrease in seizures with the ketogenic diet, and another half of the group had a 50 percent or better decrease in their seizures. Moreover, some children can discontinue the diet after several years and remain seizure-free. The ketogenic diet is not easy to maintain, as it requires strict adherence to an unusual and limited range of foods.
Possible side effects include slow growth due to nutritional deficiency and a buildup of uric acid in the blood, which can lead to kidney stones. People who try the ketogenic diet should seek the guidance of a dietician to ensure that it does not lead to serious nutritional deficiency.
Researchers are not sure how ketosis inhibits seizures. One study showed that a by-product of ketosis called beta-hydroxybutyrate (BHB) inhibits seizures in animals. If BHB also works in humans, researchers may eventually be able to develop drugs that mimic the seizure-inhibiting effects of the ketogenic diet.