Epilepsy Surgery in Turkey

Overview of Epilepsy Surgery

Epilepsy surgery is a medical procedure aimed at reducing seizures and improving the quality of life for patients with drug-resistant epilepsy. It is considered an effective option when seizures persist and are localized to a specific area of the brain, especially after failure of treatment with two or more anti-seizure medications. Before undergoing surgery, patients undergo a series of specialized medical evaluations to determine the suitability of epilepsy surgery for their condition and to identify the optimal type of surgery to achieve the best outcomes.

Indications for Epilepsy Surgery

Epilepsy surgery is an effective treatment option for individuals whose seizures do not respond to medication, a condition known as refractory or drug-resistant epilepsy. The goal of epilepsy surgery is to reduce the frequency of seizures or stop them entirely to improve quality of life and reduce health complications related to epilepsy. After surgery, patients typically need to continue taking anti-epileptic drugs for at least two years, with the possibility of gradually reducing or discontinuing them depending on the doctor’s assessment.

Proper seizure management is vital to avoid serious complications from uncontrolled seizures, which include:

Physical injuries during seizures.
Risk of drowning if a seizure occurs during bathing or swimming.
Development of depression and anxiety.
Delayed growth in children.
Memory decline and cognitive impairment.
Sudden unexpected death in epilepsy (SUDEP), a rare but severe complication.

Types of Epilepsy Surgery in Turkey

Seizures result from abnormal electrical activity in a group of brain cells called neurons. The choice of epilepsy surgery type depends on where seizures originate in the brain, as well as the patient’s age and overall health. The most common types of epilepsy surgery used in Turkey and worldwide include:

Resective Surgery: The most common type, where the surgeon removes part of the brain tissue where seizures start, often in the temporal lobes. This area is important for visual memory, language, and emotions.
Laser Interstitial Thermal Therapy (LITT): A minimally invasive technique using laser beams to target and destroy the brain tissue causing seizures. Laser guidance is aided by MRI.
Deep Brain Stimulation (DBS): Involves implanting electrodes inside the brain connected to a device under the skin of the chest that sends electrical pulses to reduce seizure-causing activity. MRI guides the procedure.
Corpus Callosotomy: Surgical cutting of the corpus callosum, which connects the two brain hemispheres, often used in children with seizures spreading across both hemispheres.
Hemispherectomy: Removal of one cerebral hemisphere, usually performed in children with multiple seizures originating from different areas of one hemisphere.
Functional Hemispherectomy: Disconnects the neural pathways between the two hemispheres without physically removing brain tissue, often used to reduce side effects in children.

Risks and Possible Side Effects of Epilepsy Surgery

The risks of epilepsy surgery vary depending on the brain area operated on, as different regions control functions such as movement, language, and memory. Risks also depend on the type of surgery and the patient’s health status. Before surgery, the medical team explains all possible risks and strategies to minimize complications. Common risks include:

Memory and language difficulties: These may affect the patient’s ability to communicate and understand others normally.
Visual changes: Surgery may cause problems with vision fields, such as loss of part of the visual field.
Mood disorders: Depression and mood swings that can impact social life and personal relationships.
Chronic headaches: Some patients may experience persistent headaches post-surgery.
Stroke: A rare but serious complication that can cause permanent weakness in parts of the body.

Understanding these risks helps patients and families make informed decisions about epilepsy surgery. Ongoing communication with the medical team is essential for postoperative care.

Preparations and Instructions Before and After Epilepsy Surgery

Before epilepsy surgery, patients collaborate with a specialized medical team in epilepsy treatment centers to perform several important tests. These preparations aim to:

Determine the patient’s suitability for surgery.
Identify the precise brain region where seizures originate.
Understand how related brain areas function to ensure vital functions are preserved.

Pre-surgery tests include:

Electroencephalogram (EEG): Records brain electrical activity during seizure-free periods to identify affected areas.
Video EEG Monitoring: Observes and records seizures, often with temporary suspension of some anti-seizure medications.
Magnetic Resonance Imaging (MRI): Creates detailed brain images to detect tumors or damaged areas.
Positron Emission Tomography (PET) and Single-Photon Emission Computed Tomography (SPECT): Pinpoint seizure activity sources precisely.
Intracranial Monitoring: In some cases, electrodes are implanted inside the brain for more accurate electrical activity recording.

Brain function evaluation is conducted through specialized tests such as:

Functional MRI (fMRI).
Wada test (intracarotid sodium amobarbital procedure).
Brain mapping during surgery.
Magnetoencephalography (MEG).

What to Expect Before, During, and After Surgery

Before surgery, you may be asked to shave or cut hair around the surgical site.
A small intravenous line is inserted to administer medications during the procedure.
Surgery is usually performed under general anesthesia, but in some cases, you may be awake to help the surgeon identify critical brain areas.
After surgery, close monitoring in the recovery room and possibly intensive care is required.
Recovery typically lasts from weeks to months, with gradual return to normal activities.
Anti-epileptic medications may continue post-surgery for a period, with gradual dose reduction depending on results.

Outcomes of Epilepsy Surgery

Outcomes depend on the type of surgery and treated brain area. For example, temporal lobe resection achieves excellent results, with about two-thirds of patients experiencing reduced or stopped seizures. Studies show:

Seizure-free rates one year after surgery range between 87% and 90%.
Good long-term outcomes persist in 82% of patients up to 10 years post-surgery.
Anti-epileptic medications can often be tapered or discontinued with careful medical follow-up.

Epilepsy surgery is an effective option for patients unresponsive to medication, and adherence to medical instructions and careful preparation helps maximize benefits and minimize risks.

Frequently Asked Questions about Epilepsy Surgery in Turkey

Why do many patients choose epilepsy surgery in Turkey?
Turkey is a leading country in epilepsy surgery due to its specialized centers, world-class medical teams, and competitive treatment costs compared to other countries.
What types of epilepsy surgeries are available in Turkey?
Turkish hospitals offer the latest epilepsy surgery techniques, including resective surgery, laser thermal therapy, deep brain stimulation, corpus callosotomy, and hemispherectomy.
How are preparations made before epilepsy surgery in Turkey?
Patients undergo specialized tests such as EEG, MRI, CT scans, and brain function assessments to ensure accurate diagnosis and the best surgical plan.
Do Turkish hospitals provide services for international patients?
Yes, many hospitals offer dedicated services for international patients, including translation, medical coordination, transportation, and accommodation to ensure a comfortable treatment experience.
What is the typical hospital stay after epilepsy surgery?
Hospital stays generally range from 3 to 7 days, depending on the surgery type and patient condition, with close postoperative monitoring.
Can patients travel to Turkey for surgery without a long-term stay?
This depends on medical evaluation, but most patients spend a short period in Turkey for diagnosis, surgery, and initial follow-up, with continued care possible in their home country.
What is the success rate of epilepsy surgery in Turkey?
Studies report high success rates of 70-90% in seizure control post-surgery, especially with appropriate patient selection and advanced techniques.