Surgery for epilepsy

Some people have poor seizure control despite trying a number of medications. There are now other treatment options available to manage epilepsy and seizures.

One of these options is surgery.

Sometimes epilepsy is caused by a small area of abnormal brain tissue. The abnormal tissue may be a result of some form of head injury, brain infection, or abnormal development - which can later turn into scar tissue and become the focus of seizures.

Many people can benefit from surgery - the goal being to stop or significantly reduce seizures without causing any neurological deficits or problems. Surgery is not usually performed unless it is likely the person will obtain a significant benefit.

Surgery may be suitable when:

• There is a focal onset of the seizures
• Seizures are of a particularly dangerous or debilitating type (such as ‘drop attacks’ or status epilepticus)
• Chronic, generalised seizures occur dozens of times a day, making normal life impossible

Epilepsy programmes for surgery are very extensive and comprehensive, involving a number of tests and prolonged monitoring. Sometimes at the end of the work-up, tests may show that surgery is not possible

What happens?

A large range of tests are performed to determine what part of the brain the seizures are originating from. The doctor or staff performing them will properly explain these tests. This is an important time to ask questions. The tests often include:

• Videotelemetry EEG
• MRI scan
• SPECT scans
• PET scan
• Neuropsychological evaluation
  This assessment determines which regions of the brain are not functioning well, indicating these areas may be related to the seizure focus. Various mental functions are tested including: problem solving; planning and organisation; attention, memory and learning; language; observation and motor abilities; behaviour and personality.
• Psychiatry
  A routine visit from a psychiatrist is common. The program is not easy and is a stressful time. The psychiatrist will evaluate how each individual is coping with their current situation, assess how they will cope with surgery and help move towards a positive outcome.

Once the entire investigation has been accomplished, a team decision is reached with regard to recommendation for surgery.

Depending on the these results, there may be a few further tests to follow.

Making the enormous decision to have surgery can be very stressful for the person with epilepsy and others involved. The need to discuss all the issues associated with such a decision is as important as the surgical procedure itself.

We recommend speaking with your doctor about surgery as an option for you. Epilepsy Action can also be of help with information about surgical options.

Do you want to speak to someone who has had surgery? If so, please email or telephone us for details.

For more comprehensive information about surgery, go to:

Surgery for Epilepsy - Massachusetts General Hospital

Epilepsy Surgery - Mayo Clinic

Epilepsy Action Australia
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