Surgery to treat epilepsy is most likely to be successful when:
Before the decision to have surgery is made, you and your doctor must consider the following factors:
The main types of surgery used to treat epilepsy are:
This procedure involves removal of the area of the brain that is producing the seizures, called the seizure focus. This procedure is only appropriate in patients who have partial seizures that occur in just one part of the brain. The surgery is often successful in reducing seizure frequency. It is especially useful in patients with certain kinds of temporal lobe epilepsy.
This involves a series of cuts along the nerve path by which seizure impulses spread. The surgery is designed to prevent seizures from spreading into other parts of the brain, while leaving the patient’s normal abilities in place. This is sometimes done alone and sometimes done in addition to a lobectomy. Alone, it is done in patients whose epileptic seizures occur in a part of the brain that cannot be removed. This surgery improves seizure control about 70% of the time. Multiple subpial transection is done less often than a lobectomy.
This surgery involves cutting the nerve connections between the right and left hemispheres of the brain to prevent seizures from spreading from one side to the other. It is often done in 2 steps. The first operation partially separates the 2 halves of the brain, but it leaves some connections in place. If the generalized seizures stop, no additional surgery is done. If seizures continue, a second operation that completes the separation may be done.
Corpus callosotomy is done primarily in children with severe seizures that start in one hemisphere of the brain and spread to the other. The surgery can help prevent generalized seizures. However, the surgery does not prevent seizures in the side of the brain where the seizure originates.
This surgery involves the removal of half of the brain's outer layer, called the cortex. It is usually done only in children whose epilepsy is not responding well to medication and who have one of these conditions:
Recovery requires intense rehabilitation in order to regain normal functions. However, after this surgery, children usually:
About half of patients need to remain on their medications after this surgery. And, about half can slowly be tapered off medications if they are seizure-free for 12 months.
The chance of recovery from this surgery is best in young children. Therefore, a hemispherectomy is done as early as possible in a child’s life and almost never done in children over age 13.
There are 2 Food and Drug Administration (FDA)-approved devices that are surgically implanted under the skin. The devices help manage seizures in people whose symptoms are not well-controlled with medication.
Epilepsy in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 11, 2014. Accessed February 17, 2014.
Epilepsy in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 11, 2014. Accessed February 17, 2014.
FDA approves medical device to treat epilepsy. Food and Drug Administration website. Available at: http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm375041.htm. Accessed February 17, 2014.
NINDS epilepsy information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm. Updated February 14, 2014. Accessed February 17, 2014.
US approves antiepileptic brain implant. Epilepsy Research UK website. Available at: https://www.epilepsyresearch.org.uk/us-approves-antiepileptic-brain-implant. Accessed February 17, 2014.
Treating seizures and epilepsy. Epilepsy Foundation website. Available at: http://www.epilepsy.com/learn/treating-seizures-and-epilepsy. Accessed February 17, 2014.
Wiebe S, Blume WT, Girvin JP, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311-318.
Last reviewed March 2016 by Rimas Lukas, MD