CESS: Children's Epilepsy Surgery Service

CESS stands for Children’s Epilepsy Surgery Service. This is the NHS service that helps children access epilepsy brain surgery.

Read about CESS, how to get a referral, and what happens after your child is referred.

 

Female doctor talking to a mother and daughter about epilepsy

Find out more about CESS

Topics covered

Key points

  • Your child might benefit from epilepsy surgery if their seizures are not well controlled with medicines
  • CESS helps children in in England, Wales, and Northern Ireland access epilepsy surgery. Children in Scotland use a different service
  • Once your child is referred to CESS, they will have several tests and scans. These will help doctors understand more about your child’s epilepsy, and whether surgery could be an option
  • If surgery is not an option, the CESS team will also consider whether other treatments could help your child. This may include vagus nerve stimulation

What is CESS?

The Children’s Epilepsy Surgery Service, or CESS, was set up in England to help children with complex or drug-resistant epilepsy. This is epilepsy that is not well controlled by medicines.

The service aims to improve access for children who could benefit from surgery. Epilepsy surgery can be life-changing for children. Overall, at least 6 in every 10 children who have surgery will stop having seizures.

Studies suggest that at least 300 children in England could benefit from epilepsy surgery each year. However, the number of children who actually have surgery every year is much lower. One aim of CESS is to help more children access surgery.

You can ask your epilepsy specialist to refer your child to CESS if you want an assessment for surgery.

Where are CESS centres located?

There are four CESS centres in England. These are located at hospitals in:

CESS centres will treat children from all over England, not just those in their local area. Full contact details for each centre are at the bottom of the page.

 

If you live in Wales or Northern Ireland

Children in Wales and Northern Ireland who need epilepsy surgery are referred to a CESS centre in England for treatment. This is arranged on an individual basis by your local epilepsy specialist. This may be a paediatrician (child specialist) or neurologist.

 

If you live in Scotland

Scotland has a separate service called the Scottish Paediatric Epilepsy Surgery Service (SPESS). CESS can also provide services to families in Scotland if their child lives or goes to school in England.

When is my child referred to CESS?

Your child’s doctor can refer your child to CESS. They may do this if your child’s epilepsy is not well controlled with medicines and they think surgery could help.

For example, your child might have one of the following:

  • Severe epilepsy that started in the first few years of life, and is thought to come from a single part of their brain
  • An MRI brain scan showing a problem in one or more parts of the brain. An example might be a benign tumour or a hypothalamic hamartoma
  • Focal Epilepsy (also called partial epilepsy) that has not been controlled with two epilepsy medicines, used either separately or together
  • A weakness down one side of the body (hemiplegia) and epilepsy that has not been controlled with two epilepsy medicines. These medicines can be used separately or together
  • Sturge-Weber syndrome
  • Rasmussen’s syndrome
  • Atonic seizures (drop attacks)
  • Tuberous sclerosis complex (TSC) with epilepsy that has not been controlled by two epilepsy medicines. These medicines can be used separately or together

 

What if my child has a different type of epilepsy?

Your child’s type of epilepsy may not fit the criteria above. But the doctor might still be able to refer your child to a CESS centre for assessment if they have drug-resistant epilepsy.

Definitions of drug-resistant epilepsy vary. It generally means that:

  • Your child’s seizures have not been controlled after trying at least two different epilepsy medicines
  • Further medicines are unlikely to help

Ask your epilepsy specialist if you are wondering whether a CESS referral could help your child.

 

Is there an age limit for CESS referral?

CESS centres will generally accept referrals for anyone up to the age of 18. There is no younger age limit for referring children to CESS.

After you reach 18 you will usually be referred to a specialist centre for adult epilepsy surgery.  If you are already in the CESS programme on your 18th birthday, the service can continue to treat you until your 19th birthday.

What happens after my child is referred to CESS?

The specialist epilepsy team will need to find out more about your child’s seizures and the type of epilepsy they have. They will probably recommend several different tests and scans.

This process usually takes some months to complete. Sometimes it can happen more quickly. It will involve several visits to hospital as an outpatient. Your child may also need to stay several days in hospital for some of these tests. We talk more about these tests below.

Going through the whole CESS process can sometimes take quite a long time. You may have a lot of different feelings as you go through.

From online groups to 1:1 befriending, we can offer you the support you need. Call our Helpline on 0808 800 5050 or go to our support page to find out more.

Overview of the CESS process

Step 1: Referral

Child is referred to CESS by their epilepsy specialist

Step 2: Assessment period

Your child will need several tests and scans to find out if surgery is an option.

This can take a number of months and might include stays in hospital.

Step 3: Your child is offered surgery or a different treatment option

If surgery is an option and you decide to go ahead, your child will be added onto the waiting list for surgery.

If surgery is not currently an option the CESS team may also consider whether other treatments like vagus nerve stimulation, or ketogenic diet could help your child.

What tests and scans will my child need?

Below are some of the tests that your child may need as part of the CESS assessment. The tests help the doctors find out more about your child’s epilepsy, and if surgery or another treatment could help.

Your child may not need all these tests. The specialist epilepsy team will decide which ones are most useful.

  • EEG and video telemetry

    EEG stands for electroencephalogram. EEG and telemetry tests tell the doctors about electrical activity in the brain. This can help them to find out more about your child’s seizures.

    EEG

    During an EEG, your child will sit or lie down. The person doing the test will attach the electrodes to your child’s head with a sticky gel. They may ask them to breathe deeply for some minutes and to look at a flashing light. These activities can change the electrical activity in your child’s brain, and this will show on the computer.

    Watch a short video called ‘A child’s guide to an EEG’, made by the UK charity Young Epilepsy.

    Video telemetry

    During video telemetry, a video recording is made at the same time as the EEG. This helps doctors to see what happens if your child has a seizure. It can help them to understand exactly which part of the brain the seizures are coming from.

    Video telemetry requires continuous video monitoring and can involve a hospital stay of a few days. In some circumstances both EEG and video telemetry may also be able to be carried out at home.

    Find out more about EEG and video telemetry tests for epilepsy.

  • Invasive monitoring

    Some children might need invasive EEG telemetry. This is a more specialised form of monitoring. It can help doctors locate where seizures are coming from in the brain. It can also tell if that area of the brain has an important function.

    Invasive telemetry involves an operation to place electrodes in or around the brain. The electrodes are attached to an EEG monitor and brain activity is recorded over several days. This procedure usually involves a stay in hospital of around 2 weeks.

    • Stereo-EEG or sEEG: This is where electrodes are carefully placed in the brain through small holes in the skull. This type of EEG is useful for looking deeper into the brain.
    • Strip or grid electrodes: Electrodes are placed directly on the surface of the brain. These types of electrodes are useful for ‘functional brain mapping’. This can show which parts of the brain control essential functions like speech, or movement. Brain surgeons use functional brain mapping to reduce the risk of any complications after epilepsy surgery
  • MRI Scan

    MRI stands for magnetic resonance imaging. An MRI scan uses a strong magnetic field and radio waves to create images inside the body.

    During an MRI scan the person lies on a bed that is moved inside the scanner. The scanner is a large tube surrounded by strong magnets. It can be quite noisy inside an MRI scanner, but it doesn’t hurt. You are given earplugs or headphones to help with the noise.

    Children can have MRI scans under sedation or general anaesthetic, or they can be fully awake.

    Find out more about MRI scans for epilepsy.

  • Functional MRI scan

    Functional MRI (fMRI) is like the MRI scan. But your child is also asked to do small tasks during the scan, such as tapping a finger, or answering questions.

    These activities increase the flow of oxygen-rich blood to a particular part of the brain. This helps doctors to see which parts of the brain manage important tasks such as language, memory, and movement.

  • PET scan

    PET scans can show how parts of the brain are working and using energy. A special dye, called a radiotracer, is injected into the arm. This dye does not hurt. It is used to gather information about the brain and highlight areas of the brain that might be causing seizures.

    PET stands for positron emission tomography.

  • SPECT scan

    SPECT scans can measure blood flow in the brain. Similar to PET scans, your child is given an injection of a special dye into a vein which shows up on the scan.

    Usually, blood flow is highest in the part of the brain where seizures start. Two scans might be used to help doctors compare blood flow during a seizure with blood flow between seizures.

    SPECT stands for single-photon emission computed tomography.

  • MEG scan

    MEG scans measure brain activity by picking up tiny changes in the brain’s magnetic field. It can tell which parts of the brain are active during a certain task. It can also help show where seizures start in the brain.

    MEG stands for magnetoencephalography.

Psychological support

Mental health professionals also work closely with epilepsy specialist teams in CESS. These include neuropsychologists and neuropsychiatrists.

They can help by:

  • Carrying out assessment tests. These can help doctors understand how your child’s epilepsy is affecting the development of skills such as memory and language. This can help with decisions around surgery
  • Advising the CESS team how to support your child’s emotional and mental health needs
  • Talking with you and your child about thoughts and feelings as you navigate the CESS process

 

Other assessments and support

Your child might have other types of assessments during the CESS process. These can depend on the type of epilepsy and challenges they have:

  • Speech and language assessments
  • Development assessments
  • Vision assessments, particularly peripheral vision (side vision)
  • Occupational therapy needs
  • Physiotherapy needs

What happens next?

The epilepsy specialist team will look at all the results of these assessments. They will use them to decide whether they think epilepsy surgery could be an option for your child.

There are several types of epilepsy brain surgery. The surgery chosen will depend on your child’s type of seizures, and where the seizures begin in their brain.

More information about epilepsy surgery for children

Find out about the different types of epilepsy surgery on our separate children’s surgery page.

You can also find out about:

What if surgery is not possible?

Unfortunately, surgery is not always possible. If surgery is not currently an option for your child, the epilepsy team will discuss with you whether other types of non-drug treatment could be helpful.

They will also develop a plan for managing your child’s epilepsy. They will then refer you on to others who can help, or back to your local epilepsy specialist.

Here are some different options that your child may be offered instead of surgery.

 

Watching and waiting

For some children, the team might recommend ‘watching and waiting’ for a period of time. This is so they can understand more about your child’s epilepsy. It can help the team make a better decision about whether epilepsy surgery could help your child.

 

Vagus nerve stimulation (VNS) therapy

VNS therapy might be offered if your child is not able to have epilepsy brain surgery. The aim of VNS therapy is to reduce the number of seizures and make them less severe. It is used as an add-on therapy alongside epilepsy medicine.

Find out more about this treatment on our VNS therapy page.

 

Ketogenic diet therapy

The ketogenic diet is a specialist diet that must be used under medical supervision. It is sometimes used as a treatment for epilepsy. Your epilepsy team may be able to refer your child to specialist dietitians and consultants who can help.

Read more about this on our ketogenic diet page.

Contact details for the CESS centres

Birmingham

Birmingham Children’s Hospital NHS Foundation Trust

Steelhouse Lane
Birmingham
B4 6NH

Tel: 0121 333 8184, 8180 and 8158

Birmingham CESS webpage

Bristol

Bristol Royal Hospital for Children

Department of Paediatric Neurology
Level 6 Research & Education Centre
Upper Maudlin Street
Bristol
BS2 8AE

Tel: 0117 3427935, 0117 3427934

Bristol CESS webpage

London

Great Ormond Street Hospital for Children NHS Foundation Trust

Great Ormond Street
London
WC1N 3JH

Tel: 020 7405 9200 extension 5594

Great Ormond Street Hospital CESS webpage

King’s College Hospital NHS Foundation Trust

Denmark Hill
London
SE5 9RS

Tel: 020 3299 3560

King’s College Hospital epilepsy webpage

The Northern Children’s Epilepsy Surgery Services (NorCESS)

NorCESS – Department of Paediatric Neurology,
2nd Floor (WARD 83),
Royal Manchester Children’s Hospital
Hathersage Road,
Manchester
M13 9WL

Tel: 0161 701 0769

Email: nor.cess@nhs.net

Alder Hey epilepsy surgery webpage

Further reading

Epilepsy brain surgery for adults Vagus Nerve Stimulations Ketogenic diet therapy Parents and children Just for kids Living with epilepsy
Epilepsy brain surgery for adults Vagus Nerve Stimulations Ketogenic diet therapy Parents and children Just for kids Living with epilepsy

Thank you to the team at Bristol Royal Hospital for Children CESS and people affected by epilepsy for their help contributing to and reviewing this content.

Find out more about how you can help us create our health information.

This information has been produced under the terms of the PIF TICK. The PIF TICK is the UK-wide Quality Mark for Health Information. Please contact website@epilepsy.org.uk if you would like a reference list for this information.
Published: November 2021
Last modified: June 2025
To be reviewed: June 2028
Tracking: A075.04 (previously B157)
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