• Information
• Publications
  • Brain and Spine Booklets
  • About our publications
  • Get involved publications
  • Case studies
• Children's resources
• Neurological centres
• Glossary
• Information Access toolkit
• Communication skills project

|

Surgery may be helpful for a small number of people with epilepsy where a clear cause such as a tumour or vascular malformation (abnormality of the blood vessels) in the brain can be identified by CT or MRI scanning. Another group of people that may be helped by surgery are those with a scar in the brain tissue, usually in the temporal lobe of the brain. However this involves major brain surgery and is not undertaken lightly.

The following criteria will usually need to be met before someone can be considered for epilepsy surgery:

1. There are no other major medical problems.

2. Anti-epileptic drug treatment is unsuitable or has been unsuccessful.

3. Seizures originate from a specific, identifiable area of the brain, usually the temporal lobe, which can be easily reached by surgery.

4. Normal brain function would not be damaged by operating on that part of the brain.

5. The person has a history of epilepsy, usually that started at an early age, or febrile convulsions as a child, frequent daytime complex partial seizures with minimal generalised activity and usually that they are under 40.

Investigation for epilepsy surgery
Several tests are usually carried out before surgery can be considered and the whole range of tests may take up to two years to complete. The tests include EEG, MRI scan, psychological and memory assessments and sometimes EEG video monitoring. Sometimes a PET scan or subdural strip monitoring is also necessary.

The surgery involves removing the part of the brain containing the damaged or abnormal structure. Modern imaging equipment, together with specialised surgical techniques mean that it is possible to very accurately locate the area to be removed and to reduce the risk of affecting healthy brain tissue.

The results of surgery in people who are selected according to these criteria are good, with control of the epilepsy being achieved in about two thirds of those who undergo the operation.

Following the surgery, there will usually be a stay in hospital of seven to 10 days, with a two to three month recovery period before it is possible to return to school or work. There is a small possibility (4-5% chance) of minor complications such as pain or infection around the operation site, but these can normally be effectively treated. More serious complications are very rare but include a 1-2% risk of stroke, memory impairment or visual disturbance.

AEDs are continued for at least a year after the operation before withdrawal can be considered. About one third of people who have undergone epilepsy surgery will need to remain on medication. Psychological and memory assessments, and MRI scans will be repeated after six months. People who have had successful epilepsy surgery often find they have to go through a period of adjustment to learn to live life without epilepsy. Follow-up care is usually continued for up to five years after the surgery.

A few specialised centres offer non-invasive surgical techniques such as radiosurgery, which uses a high-energy dose of radiation that can be focused on a precise point in the brain. These techniques and their long-term effects are still under investigation for the treatment of epilepsy.

Other methods of treatment include the use of nerve stimulation to stimulate the vagus nerve. This is useful for treatment of severe epilepsy where AEDs fail to control the seizures and where surgery is not considered to be feasible. During the treatment, a small electrical current generator is placed under the skin in the front part of the chest and wires stimulate the vagus nerve in the upper part of the neck.