Understanding Specialist Care
Surgery
Epilepsy surgery may offer seizure freedom or reduce seizure burden for some people. A comprehensive assessment helps determine whether a procedure could be appropriate for you.
About this information: This webpage is subject to continuous review by Epilepsy South Central Ontario to help keep the information current. Updates to linked pages may be in progress. This material is for informational purposes only and should not be used for self-diagnosis or as a substitute for professional medical advice, diagnosis or treatment. Consult your healthcare provider about your own health and care.
Start with Assessment
Who is a Candidate?
Suitability depends on the type of epilepsy, seizure networks, test results, overall health and the goals and risks of a proposed procedure.
Ask about specialist referral if seizures continue after adequate trials of two appropriately chosen, tolerated and used medication schedules. Some people may also be considered for assessment in other circumstances.
Surgical evaluation should not automatically be treated as a last resort. You do not need to try every medicine or every other treatment before asking about it.
Referral does not mean agreeing to surgery.
An assessment helps you understand your options. It may lead to a surgical recommendation, another treatment or further investigation. You can ask questions and discuss your preferences throughout the process.
Before a Decision
What Investigations are Required?
The team may use several investigations to understand where seizures arise and how a proposed procedure could affect important functions. Not everyone needs every test.
Seizures & brain structure
Assessment commonly includes reviewing your history, brain imaging and EEG recordings. Video EEG monitoring may involve a stay in an epilepsy monitoring unit.
Thinking, memory & further testing
Other tests may help assess cognitive functions or provide additional information relevant to surgical planning.
Follow the specialist team’s instructions. Changes to medication or sleep during monitored testing must be directed and supervised by the clinical team. Do not attempt to provoke a seizure yourself.
Different Procedures, Different Goals
What Types of Surgery are Done?
These examples are an introduction. Availability and suitability depend on the individual and the treating centre.
Resective surgery
Removes a selected area of brain tissue involved in generating seizures. Procedures may include removing a lesion or part of a lobe.
The team assesses how seizure control and important functions might be affected.
Ablation procedures
Use a targeted technique, such as laser ablation, to treat selected seizure-generating tissue. These procedures are suitable only in particular circumstances.
Ask your team whether an ablation approach is relevant and available.
Corpus callosotomy
Disconnects part or all of the main connection between the brain’s two hemispheres. It may help reduce certain disabling seizures, including seizure-related falls.
Its goal is often to reduce seizure burden rather than eliminate every seizure.
Hemispheric procedures
Hemispherectomy or hemispherotomy may be considered for carefully selected people, usually children, with extensive seizure-generating abnormalities affecting one hemisphere.
The procedure may disconnect affected networks, with or without removal of brain tissue.
What about stimulation devices?
Vagus nerve stimulation and deep brain stimulation also involve implanted devices. Their goals and assessment differ from procedures that remove or disconnect seizure-generating tissue.
Making an Informed Choice
Risks vs. Benefits
Possible benefits
Depending on the procedure, goals may include seizure freedom, fewer or less severe seizures, fewer injuries and improvements in daily life.
No outcome is guaranteed. Ask for estimates relevant to your diagnosis, proposed operation and follow-up timeframe.
Possible risks
Risks can include bleeding, infection, anaesthetic complications and changes in memory, language, vision, movement, mood or other functions. Serious complications, including death, are possible.
The type and likelihood of a complication depend on the person and procedure. Ask which effects could be temporary or permanent.
Anaesthesia, Recovery & Follow-Up
The surgical and anaesthetic teams will explain how the procedure is performed and whether any awake testing is relevant. Hospital stay, recovery and rehabilitation needs vary.
Ask about follow-up, returning to school or work, activity restrictions and whom to contact if problems occur.
Do not stop medication after surgery unless your treating team gives you an individualized plan. Seizure freedom does not automatically mean medication can be discontinued.
Questions to Bring to Your Team
- What is the goal of the proposed procedure for me?
- How likely is that outcome, and over what period?
- What are my individual risks and alternatives?
- What happens if I choose not to have surgery now?
- What support might I need during recovery?
- How will medication and seizure follow-up be managed?
Further reading:
ILAE: Epilepsy Surgery ·
Epilepsy Foundation: Risks and Benefits.