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Epilepsy surgery for adults

These pages are about epilepsy surgery for adults in the UK. If you are looking for information about epilepsy surgery for adults in another country, please contact your local epilepsy organisation.

There are several different types of epilepsy surgery. These include brain surgery, deep brain stimulation and vagus nerve stimulation.

Why is epilepsy brain surgery done?

Epilepsy surgery is done to:

  • Try to stop your seizures or
  • Reduce the number of seizures you have or
  • Make your seizures less severe

Overall, the aim is to improve your quality of life.

Will I benefit from brain surgery?

You might benefit from epilepsy surgery if you have tried a number of epilepsy medicines and are still having seizures. Your epilepsy will also have to be of a type that can be treated with surgery. Unfortunately, sometimes surgery is not possible.

Follow this link for a video on the benefits of epilepsy brain surgery for adults
touchneurology.com/gallery/neurosurgery-and-epilepsy

Types of epilepsy brain surgery

There are various different types of epilepsy brain surgery.

These are types where part of the brain is taken away, and are known as resection surgery:

  • Temporal lobectomy – in this type of surgery, brain tissue in the temporal lobes that has been causing seizures is cut away
  • Extratemporal resection – in this type of surgery, brain tissue in other parts of the brain that has been causing seizures is cut away
  • Lesionectomy – in this type of surgery, tumours, abscesses or other types of damage that have been causing seizures is cut away

If resection surgery isn’t possible for you, you might have a type of surgery where one part of the brain is disconnected from another part, such as:

  • Hemispherectomy – in this type of surgery, the outer layer of one half of the brain is removed
  • Corpus callosotomy – in this type of surgery, the connections between the 2 sides (hemispheres) of the brain are cut. This stops seizures spreading from one hemisphere to the other
  • Multiple subpial transection – in this type of surgery, the nerve fibres in the outer layers of the brain are cut. This stops the seizure activity spreading

Tests before epilepsy brain surgery

If you are being considered for epilepsy surgery, your doctors will talk to you about the tests and type of surgery you will have.

Electroencephalogram (EEG)/video-telemetry

The EEG machine records the electrical signals from the brain on a computer. During the EEG, a technician places harmless electrodes on your scalp, using a special glue or sticky tape. The electrodes are then connected to the EEG machine. 

In video telemetry, a video recording is done at the same time as the EEG. This means that if you have a seizure, doctors can see exactly what happens. It is important that everyone who may benefit from surgery has video telemetry. This is to find out exactly where in the brain your seizures are coming from. An EEG/video telemetry can be done while you are awake or asleep, or both.

Magnetic resonance imaging (MRI scan)

An MRI scan uses a strong magnetic field and radio waves to create pictures on a computer of tissues, organs and other structures inside the body. It can show if there’s a structural cause for your epilepsy.

Functional MRI scan (fMRI scan)

This is similar to the MRI scan but, during the scan, you will be asked to do something, such as:

  • Tap your thumb against your fingers or do other more difficult finger movements
  • Look at pictures
  • Answer questions on a computer screen

These activities increase the flow of oxygen-rich blood to a particular part of the brain. From these activities it will be possible to see which part of your brain manages important tasks such as thought, speech and language, movement and sensation.

Positron emission tomography (PET scan)

This scan uses a radioactive substance, called a tracer, to look for information about how the brain is working. It can also show if there’s a structural cause for the epilepsy.

Single-photon emission computed tomography (SPECT scan)

This scan shows different parts of the brain in different colours. You will be given an injection of a radioactive dye, which will go to your brain. The different colours show how much blood flow is in each part of the brain. Usually, blood flow is highest in the part of the brain where seizures start.

There are 2 sorts of SPECT scans: one is the inter-ictal and the other is the ictal. Ictal means seizure, so the ictal SPECT scan is done just after you have had a seizure.  ‘Inter’ means between, and so the inter-ictal SPECT scan is done between seizures.

Magnetoencephalography (MEG scan)

This is a newer type of scan, and is only available in very specialist centres. The scanner sits outside your head and measures your brain activity. It can tell which parts of your brain are active during a certain task.

Neuropsychology tests

These are tests that show if you have any memory or learning problems. They can take up to 6 or sometimes 8 hours, split into 2 or 3 different sessions, and involve a number of games and puzzles. The results of the tests may help the surgeon in planning the type of surgery you might need. The results can also show whether the part of your brain that will be operated on is responsible for any functions that other parts of your brain can’t take over. This is to try to make sure you will not have any problems after surgery that you didn’t have before.

Neuropsychiatry assessment

A psychiatrist with experience of assessing people for epilepsy brain surgery will see you as part of your initial assessment. They will see what other problems the epilepsy is causing. This is particularly important if you have a psychiatric illness as well as epilepsy.

Invasive EEG telemetry

In a very small number of situations, you might need to have more detailed EEG telemetry. This is called invasive EEG telemetry. The neurosurgeon will do an operation to place the EEG electrodes directly onto the surface of the brain or into the brain. The electrodes are called ‘strip’ or ‘grid’ or ‘stereo’ electrodes. The reason for invasive EEG telemetry is to find out where exactly your seizures are coming from. Another part of this test is called ‘cortical mapping’. This is to reduce the risk of any complications after surgery, when the neurosurgeon removes the part of the brain causing the seizures. These complications can include a loss of speech or paralysis down one side of the body. 

What happens during epilepsy brain surgery

What happens during surgery depends on the type of surgery you have. Usually you will have a general anaesthetic, to put you to sleep. The surgery involves making a small opening in your skull to get to your brain. Rarely, your surgeon may wake you up during part of the operation to help the operating team locate the part of your brain that controls language and movement. Your surgeon will be able to explain this to you. After the surgery, the bone is replaced, and fixed to your skull for healing. Epilepsy brain surgery usually takes several hours.

After epilepsy brain surgery

  • Your head will be swollen and painful
  • You will need to take painkillers for a few days. The pain and swelling will get less over the next few weeks 
  • You will need to rest and relax in the first few weeks and gradually become more active
  • If you work, you will need to stay off work for around 3 months
  • You will continue to take epilepsy medicines for a year or 2. But you may be able to reduce, or even stop them, after that, if you remain seizure-free

Will my seizures stop after surgery?

The chances of being seizure-free after surgery varies from person to person. Among other things, it depends on the type of epilepsy surgery, scan findings and whether all the information from tests fit together. Your doctors will be able to tell you more about the expected success rate of your surgery. They will also be able to tell you about any complications that could happen following your surgery.

What are the possible surgery outcomes?

Despite the tests before surgery, it’s not always possible to know exactly what the outcomes will be. However, following the tests before surgery, the doctors will have enough information to have a very good idea. And surgery will only be done if the benefits are greater than the risks. These are some possible outcomes related to specific types of surgery:

  • Temporal lobe surgery - Memory problems. The temporal lobes handle memory and language. This means that any surgery on these parts of the brain can cause difficulties in remembering, understanding and speaking. But, for some people, memory can improve
  • Corpus callosotomy – You may still have seizures, but they are likely to be less severe
  • Hemispherectomy - After this type of surgery a person’s area of vision may be reduced. Some people may have limited use of one side of their body

Other types of epilepsy surgery

As well as brain surgery, there are other types of surgery that can help some people with ongoing seizures.

Vagus nerve stimulation (VNS)

Vagus nerve stimulation (VNS) is a treatment where your vagus nerve is stimulated to stop your seizures. The surgery involves having a small generator that is implanted under the skin below the left collarbone. This is connected to a lead with 2 coils at one end. These coils are wrapped around the vagus nerve at the side of the neck, under the skin, during a small operation.

Deep brain stimulation (DBS)

Deep brain stimulation (DBS) is a treatment where a part of the brain is stimulated, to stop seizures. The surgery involves having a DBS system fitted.

The DBS system has 3 parts:
1. A lead – this is a thin, insulated wire. It is placed in the part of the brain where the seizure activity happens, through a small hole in the skull.
2.  A neurostimulator – this is a small device, similar to a heart pacemaker. It is usually placed under the skin near the left collarbone, lower in the chest, or under the skin of the stomach.
3.  An extension – this is an insulated wire that is passed under the skin of the head, neck, and shoulder. It connects the lead to the neurostimulator.

Further information and support

  • If you would like to find out if surgery could help you, please contact your epilepsy nurse or specialist.
  • If you have already been told that surgery could help your epilepsy, your surgeon will be able to tell you more. They will also be able to answer your questions.
  • For more, general, information about epilepsy surgery go to the Mayo Clinic website. Website: mayoclinic.com 
  • The Epilepsy Surgery Friends Facebook page is a network who share their experiences of surgery for epilepsy both before and after

If you would like to see this information with references, visit the Advice and Information references section of our website. If you are unable to access the internet, please contact our Epilepsy Action Helpline freephone on 0808 800 5050.

Code: 
F062.03

Epilepsy Action would like to thank consultant neurologist Dr Ramesh K Nekkare, of  Southern General Hospital Glasgow for their contributions to this information.

Dr Ramesh K Nekkare has declared no conflict of interest.

This information has been produced under the terms of The Information Standard.

  • Updated August 2016
    To be reviewed August 2019

Comments: read the 7 comments or add yours

Comments

Hello
I was wondering I have had it basically all my life as my dad has it and I have it can the surgery be to anyone who has it or is it not possible ?

Please could you let me know before I think about asking anyone else

Submitted by Natasha Surgenor on

Hi Natasha

Surgery would only be considered for someone if they had taken a number of different medicines and none of them had worked.

This could either be if the person was still having seizures or if the side-effects of the medicines were too difficult to tolerate.

Then the doctors would need to do a large number of tests to see if the person was suitable.

Hopefully the information on our surgery page will help you to make a decision about whether it would be a good idea to talk to your neurologist about this.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by rich on

I am still waiting to here about my surgery with Dr nekkare i have been for my pet scan and i go for my psychological assessment next month and still have to go for the ref which i will be in for 5 days but not an appiontment for that i am worried now I just got a letter today saying that my pet scan is normal does this mean I wont be getting the surgery to take away bit of tissue from my right side to try and control my seizures

Submitted by Angela Mcpherson on

Hi,
I’m 18 and I’ve had epilepsy for 4 Years, I have tonic clonic and focal sezuire. I have tried 3 different types of medication and they all worked for 2 weeks then stopped. Lemotragine made me put on weight but later it dropped off.At one point keppra made the focal seizure so much worse because it was too high dose for me and doctor apologied for not believing me when I said all this. It affected my behaviour horrendously. Carbamazepine has made no difference whatsoever to my epilepsy but I still am having to take the dose still I’m at the maximum I can take. It has given it me severe social anxiety and all throughout school and now work which I have only been doing 6 months; I’m worried it is going to cause me to leave work. I have tried therapy to help this anxiety but not a lot of difference. Over the past 4 year it has got increasingly worse. I was wondering would I have a chance in qualifying for surgery and what ones are there?

Thanks,
Soph

Submitted by Sophie on

Hi Soph

That sounds like a really tough situation for you.

Surgery is only suitable for some people. But as you have had such a difficult time with the epilepsy medicine and you are still having seizures it is certainly worth thinking about a second opinion. This would mean you had a complete epilepsy review and a consideration of what other options there might be for you. If appropriate these should include VNS and surgery. We have information on our section on getting the right treatment and care for your epilepsy. It’s called What if my seizures are difficult to control?

You might also want to look at our information on stress and on epilepsy and work.

If it would be any easier to talk to us on the phone, please feel free to contact us again on the Epilepsy Helpline freephone 0808 800 5050.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by Cherry-Epilepsy... on

i have grandmal seizures, recently started having them in clusters, i am now 28 and been on medication since i was 14 and none seems to work. i also have a vns but that does not control seizures. I also have no warning of a seizure do you think i would be able to have surgery?
thanks

Submitted by katie wilson on

Hi Katie

 

That sounds like a tough situation if nothing is working to give you seizure control.

Usually you would only be offered VNS if you are unsuitable for surgery. But there is certainly no harm in checking that out.

I wonder if anyone has talked with you about the ketogenic diet? It can be really hard to tolerate, but can make a difference to seizure control for some people.

You might also want to look at our information on getting the right treatment and care for your epilepsy. Maybe a full epilepsy review or a second opinion would be helpful? The information I have linked you to gives some guidance on this.

I do hope things improve for you soon.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by rich on

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