Evaluation before epilepsy surgery
Before a possible surgery, you should have undergone a comprehensive evaluation at the Specialist Hospital for Epilepsy (SSE) at Oslo University Hospital. The length of the evaluation varies depending on, among other things, how quickly we can record enough seizures during/with video-EEG and carry out other supplementary examinations such as imaging diagnostics. If the evaluation shows that you can be operated on, you will be applied for surgery at the Neurosurgical Department at Rikshospitalet.
The most common surgical method is to remove the epileptic focus/area in the brain where the seizures start. If MR images show changes in, or near a suspected seizure start area, the likelihood of achieving a good result with, during, or after surgery increases.
We usually cannot remove the focus/area if it is located in brain areas that are necessary for sight, hearing, movement, language, or memory, due to the risk of unacceptable functional impairments. To map important functional areas for each individual patient more precisely, it may be necessary to perform special examinations before surgery, such as functional MRI (fMRI) or Wada test.
Neuropsychological mapping and assessment
Before the surgery, it is important with neuropsychological mapping of brain function. In addition, a physiotherapist and occupational therapist map your ability to control and coordinate body movements, and function and skills in everyday activities.
Intracranial recording
In some cases, further investigation is needed to determine exactly where the seizures start. We do this by recording EEG from electrodes placed in the head (intracranial recording). After surgery with placement of intracranial electrodes, most people need some sleep for the first day. Some may experience nausea and pain for the first few days.
After surgery with placement of intracranial electrodes, most people need some sleep for the first day. Some may experience nausea and pain for the first few days.
Waiting for seizures during intracranial recording
Like other EEG examinations, we want to record seizures, in order to, if possible, determine where the seizures start. In addition, it is often necessary to perform electrical stimulation via the electrodes to map the spread patterns in the brain, locate functions, and assess vulnerability to seizures in the individual areas.
Intracranial recording lasts for a few days to a couple of weeks, depending on how frequently you have seizures. Professionals assess ongoing whether sufficient seizures have been recorded for the examination to be terminated.
The waiting time during recording can be experienced as long. Most of the time must be spent near the bed, but you can watch TV, play computer games, read books and the like. You will be staying on the monitoring ward until enough seizures have been recorded. After intracranial recording, those who have had strip or depth electrodes will stay at Rikshospitalet for a few days. They are then transferred to SSE or a local hospital. The waiting time between intracranial recording and possible surgery will vary from patient to patient depending on several factors, but usually at least about 6 weeks. This is to reduce the risk of infection.
Those who have had intracranial recording with grid electrodes, where it turns out that epilepsy surgery is possible, are most often operated on at the same time as the grid is removed. You will then be sent to SSE after approximately 4 days, and can go home after approximately 10 days.
Admission for epilepsy surgery
Admission for epilepsy surgery takes place at the neurosurgical ward at Rikshospitalet. There you will receive information about the surgery from the neurosurgeon and nurse, supervision by an anesthesiologist, and blood sampling.
The day before epilepsy surgery, there may be some waiting. In the evening, you must wash your hair and wash yourself with antibacterial soap (Hibiscrub).
You cannot eat or drink anything for the last six hours before the surgery.
Medication
