Surgical Options for Treating Epilepsy

^{Reviewed by: My Child Without Limits Advisory Committee September 2009}

When seizures cannot be properly controlled by medications, doctors may recommend that the person be considered for surgery. To decide if a person could benefit from surgery, doctors consider the type or types of seizures he or she has. They also take into account the area of the brain involved and how important that region is for everyday behavior. Surgeons usually avoid operating in areas of the brain that are necessary for speech, language, hearing, or other important abilities in order to prevent these skills from being affected.

Doctors may perform tests to find areas of the brain that control speech and memory. They often monitor the patient carefully before surgery in order to find the exact location in the brain where seizures begin. They also may use implanted electrodes to record brain activity from the surface of the brain.

Doctors generally recommend surgery only after patients have tried two or three different medications without success, or if there is an identifiable brain lesion--a damaged or dysfunctional area--that could be causing the seizures.

A study published in 2000 showed that people with certain types of epilepsy do better with surgery than with ongoing drug treatment. If a person is considered a good candidate for surgery and has seizures that cannot be controlled with medication, experts generally agree that surgery should be performed as early as possible. It can be difficult for a person who has had years of seizures to get completely used to a seizure-free life if the surgery is successful. The person may never have had an opportunity to be independent, and he or she may have had difficulties with school and work that could have been avoided with earlier treatment. Surgery should always be performed with support from rehabilitation specialists and counselors who can help the person deal with the many psychological, social, and employment issues he or she may face.

Although surgery can greatly reduce or even halt seizures for some people, it is important to remember that any kind of surgery carries some amount of risk (usually small). Surgery for epilepsy does not always successfully reduce seizures and it can result in cognitive or personality changes, even in people who are excellent candidates for surgery. Patients should ask their surgeon about his or her experience with epilepsy surgery, success rates, and complication rates with the procedure they are considering.

Even when surgery completely ends a person's seizures, it is important for that person to continue taking seizure medication for some time to give the brain time to re-adapt. Doctors generally recommend medication for two years after a successful operation to avoid new seizures.

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Devices for Treating Epilepsy

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