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epilepsy surgery

Epilepsy surgery is a name for the different types of surgery (also called neurosurgery) that some people with epilepsy have. Surgery is possible for adults and children. For some people, surgery can stop or reduce the number of seizures they have.

Surgery for epilepsy is carried out at the National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for children, both in London.  Pre-surgical assessments are carried out by our multidisciplinary team at the Sir William Gowers Centre.

Types of epilepsy surgery

There are two types of epilepsy surgery:

  • one involves removing the part of the brain that is causing the seizures
  • another involves separating the part of the brain that is causing seizures from the rest of the brain.

Can I have surgery?

You may be considered for surgery if :

  • anti-epileptic drugs (AEDs) have not stopped or significantly  reduced the number of seizures you have
  • a physical cause for your epilepsy can be found and it is only in one area of your brain.

If you meet these criteria, you will require further tests before surgery can happen. You may like to talk to your GP or neurologist about whether you are suitable for surgery.

How will I know if my epilepsy has a physical cause?

A brain scan is often used to help diagnose epilepsy and find out whether it has a physical cause. You may be asked to have either an MRI (magnetic resonance imaging) scan or a CT (computerised tomography) scan.

Physical causes can include scarring on the brain or damage to the brain from a head injury, or following an infection such as meningitis. If a physical cause is found, it is called the epileptic focus.

Pre-surgery tests

There are many pre-surgical tests you may be asked to have before you can be given the go-ahead for surgery. These could include:

  • an EEG (electroencephalogram)
  • video telemetry (an EEG while also being filmed)
  • further MRI or CT scans to get more information about the epileptic focus
  • memory and psychological tests to see how your memory and lifestyle might be affected after surgery.

The tests will help to confirm whether:

  • the surgeons can reach the epileptic focus and remove it safely without causing new problems
  • other parts of your brain that control speech, hearing , sight and movement, could be affected by surgery
  • there is a good chance of your seizures stopping after surgery
  • you have any other medical conditions that might stop you having surgery.

Sometimes the results will show that surgery is not an option. Around 50 per cent of people recommended for surgery find out, following the tests, that they are not suitable for surgery.

Deciding whether to have surgery

Having any kind of brain surgery is a big decision and it is important that you discuss all your concerns with your doctors before making up your mind to go ahead. Although your doctor can give you information and advice and discuss any potential risks, the final decision has to be yours.

You may be offered pre-surgical counselling to help you talk through your feelings and any worries.

Even after deciding to go ahead with surgery, you still have the right to opt out.

What happens after surgery?

Doctors will monitor your recovery. You may feel very tired and need to sleep for the first few days as it may take a while for the anaesthetic to wear off completely.

Some people experience seizures within the first week of surgery but this does not mean the surgery has not been successful.  Seizures are thought to be caused by the stress the brain experiences during surgery, rather than by  the epilepsy.

How long you need to remain in hospital will depend on the type of surgery you have had. Generally, doctors may expect you to be back to your  normal activities about six weeks after surgery.

Reviews after surgery

Following surgery, most people will have reviews with their doctors to monitor their recovery and any seizure activity.

How will I know if my surgery has worked?

Before your surgery, your medical team will have discussed  with you the aims of your surgery and how successful they expect surgery to be.  For some people successful surgery may be completely stopping their seizures, while for others it may be reducing the number or severity of their seizures.

It usually takes two years to measure fully how successful surgery has been.

How successful is epilepsy surgery?

Around 70 per cent of people who have surgery find that they become seizure free. Most people continue to take their AEDs for some time after surgery. You should talk to your neurologist about when might be the best time to slowly stop taking AEDs.