Epilepsy surgery

Department of Neurology

Head of Department:
Prof. Dr. med. Dr. h. c. Stefan Schwab

Epilepsy Centre

Spokesman: OA Prof. Dr. med. Hajo Hamer

In the interdisciplinary conference, neurologists, neuropsychologists, neurosurgeons, neuroradiologists, neuropathologists and medical specialists in nuclear medicine discuss in detail whether epilepsy surgery treatment should be conducted.

In this regard, the Epilepsy Centre collaborates closely with the working group which is conducting research on epilepsy surgery at Universitätsklinikum Erlangen's Department of Neurosurgery.

This interdisciplinary collaboration of several subject areas was the reason that the Epilepsy Centre was established and why the Federal Ministry of Health (BMG) awarded the Centre the highest level of care (level IV) in epileptology. The Epilepsy Centre is one of four centres in Germany with a level IV status.

If the interdisciplinary conference opts for surgery, the physicians involved plan and conduct every operation carefully using state-of-the-art technology.

There are several methods of epilepsy surgery. The decision as to which method is used in the individual case is based on the diagnostic findings.

  • Surgical resection
  • Surgical disconnection
  • Vagus nerve stimulation
  • Radiotherapy

Surgical resection:

Epileptogenic tissue is removed from the brain with the objective of obtaining seizure freedom.

To be able to treat epilepsy with surgical resection, it is important that the epileptic focus can be clearly isolated.

There must be only one focus (unifocal) which must not be located in eloquent brain areas (e.g. areas responsible for speech or motor skills) and the focus must be accessible to the neurosurgeon. In order to achieve the best possible therapeutic effect while removing as little tissue as possible, a technique called tailored resection was developed. For this surgical technique, the extent of tissue to be removed is determined using EEG recording for which electrodes are placed on the exposed surface of the brain (electrocorticography, ECoG). Neuronavigation systems, including MEG and intraoperative MRI scanners, are available to plan function-preserving epilepsy surgery.

Surgical disconnection:

Disconnection is used where resection is not possible. By severing specific nerve fibres the distribution of seizure impulses in the brain is interrupted.

In multiple subpial transection (MST), nerve fibres are cut through directly beneath the cerebral membrane. This option is used, for instance, in cases where epileptic foci are located in eloquent brain areas.

In corpus callosotomy (cutting the corpus callosum), nerve fibres are severed further beneath the brain surface. In most cases, it is not possible to achieve complete seizure-freedom. However, for patients suffering from severe drop seizures, it does represent a considerable relief.