Approximately 20 percent of people with epilepsy cannot adequately control their seizures with antiepileptic drugs (AEDs). Other people experience serious side effects from AEDs that impact their quality of life. Some of these people may be candidates for surgery.
Frontal lobectomy is surgery to remove a portion of the frontal lobe of the brain. The frontal lobe is the part of the brain responsible for executive functions such as motivation, concentration, organization, mood, and impulse control. Partial seizures often originate in the frontal lobe.
Not everyone with intractable epilepsy is a good candidate for frontal lobectomy. Frontal lobectomy is most effective in people who experience partial seizures that originate in the frontal lobe. In addition, it must be possible to remove the seizure focus without disrupting important brain functions. To qualify for frontal lobectomy, you must have tried several different AEDs for significant periods of time. Finally, you and your doctors must agree that the benefits you might gain by undergoing the surgery outweigh the risks of performing the procedure.
What does it involve?
Your neurologist will perform extensive testing to decide whether you are a good candidate for frontal lobectomy.
During the frontal lobectomy, the neurosurgeon will make an incision in your scalp and retract a flap of skin. The neurosurgeon will then remove a section of your skull in a procedure known as a craniotomy. Next, the neurosurgeon will retract a section of the dura mater, the tough outer covering of the brain. Viewing your brain through a surgical microscope, the neurosurgeon will insert instruments. For a portion of the surgery, you may be put into a sedated, twilight state, just conscious enough to respond to questions. Doctors or nurses may ask you to count, describe images, or other tasks to help the neurosurgeon pinpoint which sections of your brain are responsible for which functions. The neurosurgeon will cut away the portion of the frontal lobe containing the seizure focus. When the neurosurgeon is finished performing the frontal lobectomy, they will close the dura mater, fix the skull back in place, and finally close your scalp with staples or stitches.
You can expect to stay in the hospital for two to five days after receiving frontal lobectomy surgery. Once you return home, it will take approximately one month to recover completely from surgery and resume work, school, or other normal activities. Your hair will hide the scar when it grows back.
You will likely continue taking your AEDs after surgery until your neurologist establishes how effective the surgery was in controlling your seizures. You may eventually be able to reduce or stop taking your medications. You should never suddenly stop taking an AED. Always consult your neurologist for a plan to taper off gradually to avoid withdrawal.
Frontal lobectomy may help eliminate or reduce seizures, and it may reduce the number or amount of medications you need to take to control your epilepsy.
After frontal lobectomy, between 30 to 50 percent of people are free of seizures that affect consciousness and movement. Approximately 20 to 40 percent of people continue to have seizures, but the frequency of seizures is reduced by 90 percent. Twenty to 30 percent of those who undergo frontal lobectomy show no significant improvement.
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.
Frontal lobectomy surgery may not be successful in reducing or eliminating your seizures.
Frontal lobectomy surgery can cause pain and swelling, and you will most likely need pain medication for some weeks during recovery. Other temporary side effects may include paralysis, personality change, fatigue, depression, headaches, numbness in your scalp, nausea, and trouble remembering or speaking some words.
Possible complications of frontal lobectomy include swelling in the brain and damage to healthy brain tissue. Damage to the frontal lobe may result in problems with organization, attention, motivation, mood, and impulse control.
Some people become anxious if they experience a seizure after surgery. A seizure after surgery does not indicate that the surgery was unsuccessful. It may be necessary to examine seizure triggers or adjust medication to reestablish control. Even if seizures are eliminated, you may continue to experience auras, the sensations that signal the beginning of a seizure.
Even if surgery is successful at completely controlling seizures, some people have trouble adjusting to life without seizures. Although it is a positive change in many ways, it can create stress and put pressure on interpersonal relationships. Seek support or therapy if you find yourself becoming depressed or anxious due to changes in life after surgery.
Frontal Lobectomy – Epilepsy Foundation
Surgery – Epilepsy Foundation
Types of Epilepsy Brain Surgery – Healthline
Epilepsy Surgery – Mayfield Clinic