Surgery for epilepsy

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When surgery is considered

Despite trying a number of medications some people still continue to have seizures. There are other treatment options available to help manage epilepsy and seizures.

One of these options is surgery.

Some people, predominantly those with focal epilepsy, can benefit from surgery. Sometimes epilepsy is caused by a small (focal) 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.

The goal of epilepsy surgery is 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 gain significant benefits.

The most common type of epilepsy surgery aims to remove the epilepsy ‘focus’ – where the seizures start in the brain. Sometimes this focus is obvious and can be seen on scans, and sometimes it is not any may only be detected after a period of monitoring.

Surgery may be considered when:

  • Seizures are not responding to medication
  • There is a focal onset of the seizures
  • Seizures are of a particularly dangerous or debilitating type (such as ‘drop attacks’ or status epilepticus)
  • Seizures occur many times a day, making normal life impossible
  • The cause of the seizures requires surgery, such as a brain tumour

Epilepsy surgical programs are based in epilepsy centres at major public hospitals. The work-up to surgery involves a number of tests and monitoring and recording of seizures. There is a chance that at the end of the work-up, tests may show that surgery is not possible without risk.

What happens?

A large range of tests are done to pinpoint what part of the brain the seizures are originating from. These will be explained to you before they are done. This is an important time to ask questions.

The tests often include:

Once the entire work-up has been finished, test results are compiled, and a team decision is made as to whether successful surgery is possible. Depending on this outcome, there may be a few further tests to follow.

Making the decision to have surgery can be very stressful. Before surgery, it is essential to discuss all your worries or concerns with your neurologist and epilepsy nurse.

If your seizures are not well controlled with medication, speak with your doctor about surgery as an option for you.

For more information about surgery:

Factsheet –  Surgery for Epilepsy 

Videos

Epilepsy Surgery Mayo Clinic