Epilepsy Surgery: An Underused Treatment Option (Podcast)

Epilepsy surgery is a viable treatment option when more than two appropriately prescribed medications fail to control seizures. However, it remains significantly underutilized.

“Every patient is a surgical candidate once they fail a couple of medicines,” says William Bingaman, MD, Vice Chair of Cleveland Clinic’s Neurological Institute and Director of the Epilepsy Surgery Program in its Charles Shor Epilepsy Center. “The trick then is just to be able to tell patients what their chances are to become seizure free so they can drive, work or even just take a bath or shower by themselves without fear of drowning.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Bingaman discusses the state of epilepsy surgery and its value in the care of individuals with uncontrolled epilepsy. He touches on:

• The evolution of epilepsy surgery
• Factors that contribute to low surgical referrals
• Types of epilepsy procedures, including resection, palliative surgery and laser ablation
• The role of magnetoencephalography and imaging modalities
• The future of epilepsy surgery and drug delivery into the brain

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the episode

Podcast host Glen Stevens, DO, PhD: The great news is that there are a lot of epilepsy drugs out there now, versus when you and I started to practice. In some ways, the bad news is that there are a lot of epilepsy drugs out there. It becomes easy for neurologists to say, “Well, let’s try this new drug,” doesn’t it?

Dr. Bingaman: It could take 10 or 15 years probably to go through all the drugs on a fair trial. It reminds me of a patient I saw last year who came up from central Ohio. She was in her late 60s, and she had hippocampal sclerosis, the most common adult epilepsy we see and also the type that responds most successfully to epilepsy surgery. She had a febrile convulsion as a baby. At 15, she started having seizures and had been seizing for 50 years.

She and her husband were sitting in my clinic and we were talking about temporal lobectomy, which we typically don’t do on people in their 60s. Occasionally we do, but it’s rare. So I said, “Gosh, you’ve had seizures for 50-some years. Why now? Why are you here now?” And she looked at me and said, “Well, I didn’t know surgery was an option.” … That’s unfortunately something we still see, and 50 years of uncontrolled epilepsy can really do a number on someone.