It is advisable to plan the treatment with a specialist doctor who treats epilepsy viz a neurologist or an epilepsy expert. However, about 20-30% of people with epilepsy continue to have seizures despite medications. Some of these patients can benefit with brain surgery. The decision for suitability for surgery depends on detailed investigation results. The following studies are particularly useful in identifying the epileptic firing focus during the presurgical evaluation.
Long Term Video EEG (Electroencephalogram) Evaluation: It is one of the key tests performed to establish the diagnosis of spells whose epileptic nature is not certain and to determine the area in the brain from which the seizures originate (epileptic focus).
Tesla MRI: This is very useful in identifying subtle anatomical lesions that may be missed on routine MR images.
Functional MRI: This aspect of MR evaluation studies identifies areas of the brain associated with specific functions like the arm and leg movement, and vision, speech and language. This is useful for non-invasive planning of surgical strategies, such that post-surgical motor, visual or language deficits may be avoided.
SPECT & PET-CT: These are also available to evaluate more challenging patients with focal epilepsy and a normal MRI. These are used to provide visual evidence of the functional epileptic firing focus.
Neuronavigation System: This equipment is available in the operation theatre to provide surgeons with online MR imaging orientation of his surgical field. This greatly improves precision during surgery.
Intraoperative MRI (IMRIS): This system allows the surgeon to perform an MRI study in the operation theatre. This allows the surgeon to ensure complete resection of the epileptogenic lesion, which is crucial for seizure freedom.