Weill Medical College of Cornell University

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Mapping Brain Function Prior to Surgery

After determining the part of the brain responsible for the seizures, the epilepsy surgical team predicts any major problems with speaking, understanding, or other abilities that could arise if a specific area of the brain is removed. The neurosurgical approach is tailored to (1) obtain maximal seizure control and (2) minimize any dysfunction or difficulties afterward. The objective is always to improve quality of life.

Some of the brain tissue responsible for seizures is typically abnormal tissue, such as scar tissue, tumor, or tissue that improperly became located in the brain during early development. The removal of abnormal tissue may control the seizures and will not cause any change in the person's functioning. However, in other cases, brain tissue which gives rise to seizures is located near areas of the brain important for speaking, understanding, moving, remembering, or other important human abilities.

During functional mapping, extensive careful testing helps determine the function of an area being considered for surgical removal. In some cases, the function of the part of the brain considered for surgical removal is briefly interrupted. Then it's established that the individual can still speak, understand, wiggle fingers, make puppets, cut sandwiches - do all the things he the patient can ordinarily do - even though there has been interruption of the function of that part of the brain responsible for seizures. As well, there may be centimeter-by-centimeter functional mapping of the brain, using intracranial electrodes. In all cases, it's critical to insure that proposed surgery to control seizures will not create any long-term problems for the patient. All information gathered from functional mapping of the brain is shared with the patient and his or her family to help them make an informed choice regarding surgery.