Procedure guide · Neurology and neurosurgery
Epilepsy surgery removes or disconnects the area of the brain where seizures start. It is considered when medicines have not controlled seizures. An NHS epilepsy service says this usually means two or more medicines have failed. A detailed evaluation comes first. It finds out whether surgery is possible and what the risks are.
What is epilepsy surgery?
University College London Hospitals (UCLH) describes open surgery to remove or ablate the area where seizures start. It also describes laser interstitial thermal therapy, a keyhole option. Some operations are done awake when the target is near areas for speech or movement. The NHS also lists vagus nerve stimulation as another treatment. A small device under the chest skin helps reduce seizures.
Who may be considered?
UCLH lists the usual conditions. Two or more anti-seizure medicines have not stopped seizures. Tests show the seizures start in one area. That area can be removed without harming speech, sight, movement, hearing or memory. No other medical problem makes surgery dangerous.
UCLH is open about risks. Memory can worsen after surgery. Mood problems such as anxiety or depression can occur. Some people still have seizures in the early period. No team can promise seizure freedom. After all the tests, a multidisciplinary meeting decides whether surgery is advised.
Which tests are part of the evaluation?
UCLH describes these tests:
- video-EEG telemetry, which records typical seizures on EEG and video during a hospital stay
- detailed brain MRI
- neuropsychology tests of memory, language and thinking
- a psychiatric assessment
- PET or SPECT scans in some cases
- intracranial EEG with electrodes on or in the brain, when other tests are unclear
Before you travel, send your neurologist’s letters, all EEG reports, MRI images in original format, and a list of medicines tried with doses. A seizure diary helps. So does a video of a typical seizure if a family member has recorded one.
Evaluation may be a trip of its own
Some tests need a hospital stay and may need medicine to be reduced under supervision. The team may advise evaluation first and surgery on a later trip.
How do you plan the trip?
The stages are records review, evaluation tests and the team meeting. If surgery is advised, the operation and recovery follow. An attendant should stay throughout, especially during video-EEG when seizures are expected. Before discharge, ask for a clear medicine plan. Ask also for a follow-up plan your neurologist at home can manage. Your team decides when it is safe to fly.
What should you ask the hospital?
- Which evaluation tests do you need, and which of my results can you use?
- Will my case be reviewed at a multidisciplinary meeting?
- What do the tests suggest about the risk to memory or speech?
- Is open surgery, laser therapy or a device such as vagus nerve stimulation being considered?
- How will my medicines change after surgery?
- How will you share the results with my neurologist?
Questions people ask
Why is a video-EEG needed before epilepsy surgery?
UCLH explains that video-EEG aims to record at least one typical seizure. This helps show where seizures start. Medicines may be reduced under supervision to make a seizure more likely during the test.
Will I still need epilepsy medicines after surgery?
Your neurologist decides. Most teams continue medicines after surgery and review them over time. Ask for a written medicine plan before you leave the hospital. Do not stop or change any medicine without your neurologist’s advice.
What is laser interstitial thermal therapy?
UCLH describes it as a keyhole procedure that uses laser light through a very small drill hole to treat the area where seizures start. It calls it an emerging option. Your team will say whether it is relevant to your case.
Sources
- University College London Hospitals NHS: A guide for patients considering epilepsy surgery
- NHS: Epilepsy – treatment
- MedlinePlus: Brain surgery
General information, not medical or legal advice. Rules change: confirm with the official source. Your treating specialist decides on suitability, treatment and length of stay. How we write and check.