Epilepsy Surgery

Pre-Surgical Evaluation

24 February 2018
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Pre-Surgical testing aims to locate the area in your brain where the seizures start. Tests will also determine if it is safe to remove this area and improve your seizure control. This can be a lengthy process involving a number of tests, some of them requiring a stay in hospital.Below is the typical journey to epilepsy surgery.

Pre-Surgical Tests

1. Video EEG Monitoring (vEEG)

This study involves a prolonged EEG recording, as an inpatient a specialised unit called the Epilepsy Monitoring Unit (EMU). Video EEG will help identify the area of your brain where the seizure starts by recording your brains electrical activity from the surface of your scalp. In order to record seizures, your doctors may need to reduce your anti-epileptic medication and/or sleep-deprive you.

The National Epilepsy Surgical Programme currently has 2 main sites for monitoring adults with dedicated EMU nurses. The Beaumont Hospital EMU has 4 adult beds. Cork University Hospital EMU has 2 adult beds. Children are currently usually monitored in Temple St Children's Hospital Dublin or Crumlin Children's Hospital Dublin.

2. Specialised Imaging - MRI, fMRI, CT, PET: 

These tests look at the structural anatomy of the brain. Doctors look at these images in conjunction with EEG to determine the area in your brain where the seizures originate. Your doctor may request other specialised scans to help plan or consider your surgery. These will be discussed with you if necessary

3. Neuropsychological Evaluation

This is carried out by doctors who specialise in testing and interpreting your brains functions. They will evaluate special skills such as memory, language and speech and will consider how epilepsy surgery will be safely carried out.

  • WADA Procedure: This maybe required prior to surgery to lateralize language and memory function. This is a type of angiogram and is done as a day case in Beaumont Hospital. If you require this test you will receive detailed information about it.

4. Psychiatry

Your Doctor may request for you to meet with a psychiatrist to assess how epilepsy surgery will impact on our mood and mental wellbeing.

5. Intercranial Video EEG monitoring (phase II monitoring) 

If tests have not determined the exact location of the seizure focus, intercranial Video EEG monitoring may be needed. Your Doctors may recommend for you to have an operation where specialised recording electrodes are surgically placed on and into the brain. Another period of video monitoring in the Epilepsy Monitoring Unit is carried out with the electrodes in place and this can give more detailed information of where your seizures start. This procedure will be fully explained to you if necessary.

6. Epilepsy surgery review conference

When all or most of your pre-surgical testing is complete, your neurologist will meet with our team at the Epilepsy Surgery Programme in Beaumont. This team is made up of a Neurosurgeon, Neurologists both adult and paediatriac, Psychologists, Psychiatrists, Neurophysiologists, Epilepsy Nurse Specialist. As a group, they recommend a plan of how best to safely treat your seizures with surgery. If they decide surgery cannot be performed safely they will recommend other options to be explored.

7. Outpatient department

Once you are considered a suitable surgery candidate, you receive an appointment to meet with your Neurosurgeon and Epilepsy Surgery Nurse who are part of the Beaumont Epilepsy Surgery Programme. 

During this appointment you can discuss in detail the type of surgery you are having, how it will help your epilepsy and the risks associated with your epilepsy surgery. Your surgical team will answer any questions you have regarding your operation at this appointment. It is helpful to take a relative or friend with you and to write down any questions you may have before this meeting.

Meeting to discuss surgical options to treat your seizures is not a commitment to having epilepsy surgery.

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