14  Epilepsy Surgery

There are many types of epilepsy surgery. In broad terms, epilepsy surgery is when a neurosurgeon removes, disconnects, or ablates the part of the brain involved in generating seizures. It can also mean a procedure in which the surgeon implants a device that stimulates part of the brain or nervous system.

In the past, epilepsy surgery was seen as a last resort, to be considered only after every other option had been exhausted. We now know that surgery can be a worthwhile treatment for many people with epilepsy, and that it should be considered as soon as the epilepsy becomes drug-resistant, meaning seizures have continued despite two appropriate antiseizure medications at adequate doses.

14.1 Goals of Epilepsy Surgery

Ultimately, the goal of any epilepsy surgery is to improve quality of life. Some types of surgery have a curative intent, while others are meant to be palliative.

• Curative surgery is intended to stop seizures completely.
• Palliative surgery is intended to significantly reduce the burden of seizures. It is usually not expected to stop them entirely.

Your epilepsy team will review the options and the type of surgery that fits your child’s situation.

14.2 Who Is a Good Candidate for Epilepsy Surgery?

Any child whose epilepsy is drug-resistant should be referred for an evaluation to see whether surgery is an option. A referral is not a commitment to surgery; it is a way to gather information. Your doctors weigh a number of factors when deciding whether surgery is likely to help.

When considering a curative approach, the first step is determining the type of epilepsy and whether the seizures are coming from one particular area of the brain. The evaluation usually begins with the EEG, the MRI, and the pattern of the seizures, and may go on to include advanced imaging or stereo-EEG when a clearer answer is needed.

If the seizures do appear to come from one area, the next step is to determine whether that area can be safely removed or disconnected without causing new problems with movement, language, memory, or other important functions.

14.3 An Evaluation Does Not Commit You to Surgery

Having an evaluation does not mean surgery is decided. Some families weigh their options afterward and choose not to move forward, or decide to revisit the question later. The purpose of the evaluation is simply to understand what is possible, so that any decision you make is a fully informed one.