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Epilepsy Surgery   In recent years epilepsy surgery has become a well recognised treatment for certain types of epilepsy. Here are answers to some of the questions commonly asked by patients considering surgery.   Why is surgery used to treat epilepsy? Epilepsy is sometimes caused by an area of abnormal brain tissue which triggers seizures. This area of abnormal tissue is referred to as an ‘epilepsy focus’. There are many reasons why such abnormalities occur and they may be insignificant unless they cause seizures. If surgery can remove the epilepsy focus, seizures can often be prevented. The size and position of the focus can vary. The chance of successful surgery and the risks of complications are different for each patient.   Surgery is usually only used where medication fails and it is not intended to be a substitute for medication. If surgery is considered to be a possible treatment for your epilepsy, extensive tests will first be carried out. Your doctors will then discuss with you, the possible outcomes from surgery in your case, so that you can make an informed choice.   How do I prepare for surgery? When surgery is planned and you are waiting for admission to hospital, maintain your normal lifestyle and continue to take your medication as prescribed. You can usually expect to be in hospital 7-10 days so pack nightwear, something comfortable to wear while you are out of bed during the day and any personal requirements. Be prepared in case you are called in at short notice.   If you smoke, it is recommended that you try to stop. If you are having difficulty stopping, discuss this with your doctor. Nicotine substitutes may be recommended. Smoking is not permitted in hospitals. It’s important that you don’t smoke for the 48 hours prior to surgery.   You do not need to cut or shave your hair before you go to hospital. On the day of surgery, only the hair around the operation area will be shaved. The rest of your hair will not be cut.  After surgery some people decide to trim their hair short, but others, especially those with long hair, find they can comb their hair to hide the surgical cut, which is usually within the hairline.   If you are unwell in the week before surgery, please consult your doctor.   What happens during the surgery? You will usually be admitted to hospital for routine tests, the day before your surgery. On the day of surgery you will not be allowed to eat or drink for several hours before the operation and one hour before going to the operating suite you will be given a light sedative.   In the operating suite you will meet the team of doctors and nurses caring for you. The anaesthetist will insert a fine needle into your vein to administer medication and you will be taken to the operating room where you will be anaesthetised and fall asleep. (Some surgery is performed with the patient awake. If this applies to you, you will have been informed previously.) Once asleep, your hair will be shaved over the operation site. The skin is wiped with antiseptic solution and drapes arranged to keep the area sterile. The skin and muscle are cut to expose the skull and a piece of bone is removed. The dura (tissue covering the brain) is cut, the brain exposed, the area causing problems is removed and the dura is closed. The bone is replaced and in most cases held in position with metal plates. After the muscle is rejoined, the skin is usually closed with surgical staples, which are easily removed after 7 days. When you wake you will have a small dressing over the staples or a bandage around your head.   What happens when I wake up? When you wake after surgery, you will be carefully observed and made comfortable, with medication for pain if required. You may have an intravenous tube in your arm to provide fluids. After bed rest for approximately 2 days you will be assisted to sit out of bed and gradually begin to walk and shower with supervision.   You will often feel very tired after your operation. This is due to the combination of having an operation and the time spent in bed whilst in hospital. Although visitors are welcome, they can tire you, so ask your family or the nursing staff to limit visitors if you wish.   You will usually be discharged from hospital after 7-10 days depending on the type of surgery you’ve had and how you are feeling.   Are there any side effects of the surgery? There are several serious side effects of any brain surgery which your doctors will discuss with you. These include bleeding, injury to the brain and infection of the brain or bone. Fortunately these complications are rare. In addition, a small number of patients will have a seizure immediately after their operation. This does not necessarily mean the surgery was unsuccessful, or that seizures will continue. It is the result of having had an operation on the brain and usually settles very quickly.   There are a number of common, less significant side effects.   ·         Dizziness may occur after surgery. Often when patients first get out of bed they feel dizzy and are unsteady on their feet. This usually settles within 24-48 hours.   ·          Headache and jaw ache are common after epilepsy surgery especially around the forehead and temple. Cutting the temporalis muscle may be the cause. This muscle is attached to the temple at one end and the jaw at the other, so you might notice pain for the first few weeks when eating or yawning. This settles in almost all cases.   Headache can increase when the pressure inside your head increases, as with sneezing or straining. Since constipation is common after an operation, bowel actions can increase your headache.     ·          Swelling or bruising of the face or head near the surgery area is also common. This reduces quickly in most cases.     ·          Superficial infection of the skin may occur.     ·          Blurred vision may occur. It usually settles after several weeks but may take three months. Consult your doctor before changing your glasses prescription.     ·          Sensations of ‘clunking’ at the site of the surgery do not mean the bone has moved. It is held in place by metal plates. Swishing noises in your head, or feeling that fluid is present directly under the skin are due to fluid pathways in the brain settling down after surgery.     ·          Numbness occurs where skin is cut and scars form. This decreases with time, but some numbness may be permanent.     ·          Feeling depressed after surgery can be common for many reasons. However, after epilepsy surgery up to 30% of people have a temporary clinical depression, which often resolves itself but at times needs treatment. Therefore if you are depressed or concerned about any matter, do not hesitate to contact your neurologist.     ·          Other issues may cause you concern. For example, impotence in men or dysfunction of the menstrual cycle in women can occur. These usually subside within a few months and are thought to be due to temporary hormonal disturbance. Do not be embarrassed to raise these, or other  questions with your neurologist.     ·          If you have temporal lobe surgery, you may notice a slight dip in the tissue beside your ear. If this concerns you consult your doctor, as it may be possible to improve this appearance. Difficulty raising your eyebrow is usually due to temporary nerve bruising which can settle in three months.   What should I do when I go home? When you go home you may feel very tired because you have been through a stressful experience, an operation and days with little exercise. A balance of rest and activity will help you to regain your normal energy and confidence.   The following suggestions are general guidelines, however, each person recovers at their own pace and your doctor may suggest a particular program of recovery for you.  Follow any instructions about pain medication carefully and continue your epilepsy medication as prescribed. If you notice any unexpected symptoms such as a fever, or changes in your general health, please contact your neurologist.     ·          Wound Care Your wound should be healed by the time you leave hospital. During the first few weeks, you may need to have a family member or friend observe the suture line for signs of redness, swelling or discharge.   You can wash your hair as usual with normal shampoo and conditioner to keep the area clean, but do not rub directly on the scar for the first week. It is recommended that you refrain from using hair dye for a minimum of 3 weeks after surgery.     ·          Activity Each day, you can expect to get up and dressed. Aim for a good night’s sleep and allow one or two rest periods during the day in the early weeks as required. Daytime sleep is not recommended if it disturbs your night sleep.   As soon as you feel able, begin to exercise by walking at a comfortable pace. Build to approximately 20 minutes twice daily after three weeks, or the target recommended by your doctor.   Return to part time work or study might be expected at approximately 6-8 weeks, depending on your job, gradually increasing to full time by 3 months if your doctor agrees. Be patient with yourself. The rate of improvement will vary for each person.   Continue to ensure regular sleep patterns as you increase your activities and avoid contact sports for 6 months.     ·          Follow-up After surgery you will be followed up at a multi-disciplinary clinic, or by your neurosurgeon, neurologist and other members of the health care team individually. Your first appointment will be made approximately 3 weeks after discharge from hospital, but you are free to contact your doctors earlier if you feel it is necessary.     ·          Alcohol, Smoking and Driving Your neurologist will advise you about alcohol intake. The recommendations you followed prior to surgery are likely to continue after surgery.   Driving is not allowed for a minimum of 12 months following epilepsy surgery (providing you are seizure free) and before you are permitted to drive you will need the approval of your neurologist.   It is advised that you do not continue smoking after the operation for medical reasons. However, if you choose to continue you should wait at least one week after your surgery.   ·          Medication Your epilepsy medication will continue after surgery as instructed by your neurologist. Women taking epilepsy medication are advised to discuss issues of contraception and pregnancy with their neurologist.       Will epilepsy surgery change my life? It is not possible to anticipate exactly what a person’s life will be like after epilepsy surgery. People who become seizure free will need time and perhaps support, to adapt to the changes in their lives. Where surgery is not as successful as anticipated there may be disappointment. The doctors and other health professionals in an epilepsy surgery unit recognise that these are important issues and offer long term follow up and support.     Information and Support A person considering epilepsy surgery will have many questions. These may concern the pre-surgery tests, the operation itself, or the recovery period. Your neurologist, neurosurgeon and the team of health professionals supporting you through this process, can provide current information relevant to your situation. Do not hesitate to ask for information or raise any concerns.   You may discover that modern advances in epilepsy surgery are not well understood in the community and your friends or family might express fear and concern about your decision to have surgery. Epilepsy Foundation staff, and Foundation members who have experienced surgery themselves, are very happy to speak with you or your family when surgery is being considered. Support is also available to help you in the months after your operation.   The Epilepsy Foundation has a two bedroom flat available for patients and/or their companions, who are visiting Melbourne for epilepsy treatment.     Epilepsy Foundation of Victoria Inc. 818 Burke Road Camberwell 3124   Telephone (03) 9805 9111 Fax (03) 9882 7159 National Help Line 1300 852 853 Office Hours: Monday–Friday   9am - 5pm email: epilepsy@epilepsy.asn.au       Prepared by   Rosemary Panelli - Epilepsy Foundation of Victoria Inc.         Mr Michael Murphy - Surgical Director Assoc. Prof Mark Cook - Medical Director  Dr Terry O’Brien - Neurologist Josephine Gorman - Co-Ordinator The Victorian Epilepsy Centre at St Vincent’s Hospital and the Alfred Hospital.   This brochure remains the property of The Victorian Epilepsy Centre at St Vincent’s Hospital and the Alfred Hospital in conjunction with the Epilepsy Foundation of Victoria Inc. It may not be reproduced in any form either partly or completely, without appropriate acknowledgment of the source. The Victorian Epilepsy Centres comprise the Alfred Hospital, the Austin and Repatriation Medical Centre, the Royal Children’s Hospital, Monash Medical Centre. St Vincent’s Hospital and the Royal Melbourne Hospital.   Disclaimer: This brochure provides a general overview of epilepsy surgery. However, it does not provide specific advice and any change to your medication or lifestyle, or specific questions concerning surgery must be directed to your neurologist or neurosurgeon.