Epilepsy brain 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.

This information is about adult epilepsy surgery. We have separate information about epilepsy surgery for children.

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.

Could I benefit from brain surgery?

You might benefit from epilepsy surgery if you have tried two or more epilepsy medicines and they have not stopped or reduced your seizures. This is sometimes known as having ‘drug resistant epilepsy’.

The National Institute for Health and Care Excellence (NICE) says that people with drug-resistant epilepsy should be offered a referral to a specialist epilepsy centre to see whether surgery could help.

You can also be referred for an assessment early, if you’ve had an MRI scan which shows you have a problem in your brain that puts you at high risk of having drug-resistant epilepsy.

Before making a referral, your epilepsy specialist should talk to you about:

  • Your treatment options
  • The assessment process
  • The possible risks and benefits of having surgery

As part of the assessment, you will be able to ask questions and have time to think about any surgery offered to you. You can come to a shared decision with your epilepsy specialist about the right way forward for you. Family and carers can also be part of these conversations, if this is something you would like.

What types of epilepsy brain surgery are there?

There are various different types of surgery.

Below are types where part of the brain is taken away. This is known as resection surgery:

  • Temporal lobectomy – brain tissue in the temporal lobes that has been causing seizures is cut away. The temporal lobes are responsible for understanding language, memory and hearing
  • Extra-temporal resection – brain tissue in other parts of the brain that has been causing seizures is cut away. This is any brain surgery that takes place outside the temporal lobes
  • Lesionectomy –  tumours, abscesses or other types of damage that have been causing seizures is cut away
  • Hemispherectomy – in this type of surgery, the outer layer of one half of the brain is removed

Below are types where one part of the brain is disconnected from another part. This surgery is to make your seizures less severe:

  • 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. It is aimed at stopping falls and injuries
  • 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. It is used for people with Landau-Kleffner syndrome. The aim is to reduce or stop seizures.

What tests would I have before epilepsy brain surgery?

If you are being considered for surgery, these are some of the tests you might have, during your assessment.

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.

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.

Magnetic resonance imaging (MRI scan) - An MRI scan uses a strong magnetic field and radio waves. This creates 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) - 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.

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 on the scan 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.

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 from 6 to 8 hours and are split into 2 or 3 different sessions. and involve a number of games and puzzles. The test results may help the surgeon in planning the type of surgery you might need. The results can show whether the part of your brain to be operated on has 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.

How long would the assessment process take? 

It may take several months to complete the assessment process.

Where would I have epilepsy brain surgery?

You would usually have your surgery at a specialist surgery centre. This might not be your local hospital.

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 locate the part of your brain that controls language and movement. They will be able to explain this to you. After the surgery, the bone is replaced, and fixed to your skull for healing.

The surgery usually takes several hours, and you will be in hospital for around 5 days.

How might I feel after epilepsy brain surgery?

After your surgery you might have some, or all, of the following:

  • Headache
  • Fatigue
  • Low mood
  • Bruising or swelling to the face
  • Constipation
  • Pain when chewing and yawning

You will need to rest and relax in the first few weeks and gradually become more active. If you usually work, you will need to stay off work for around 2-3 months.

Will my seizures stop after epilepsy brain surgery?

The chances of being seizure-free after surgery varies from person to person. Among other things, it depends on the type of surgery, and what your scans show. Your doctors will be able to tell you more. They will also be able to tell you about any complications that could happen following your surgery.

Would I be able to stop taking epilepsy medicines after epilepsy brain surgery?

Some people might be able to stop taking their epilepsy medicines after surgery. But they would usually carry on with it for at least the first year. Your neurologist will be able to give you more specific advice.

What might the outcome of epilepsy brain surgery be?

It’s not possible to know exactly what the outcome will be. But surgery will only be done if doctors believe that the benefits are greater than the risks.

What might the risks of epilepsy brain surgery be?

Memory

People with epilepsy often have memory problems. This is particularly for people with temporal lobe epilepsy, as the temporal lobes are responsible for memory.

Surgery for temporal lobe epilepsy usually involves removing part of the temporal lobe. If you already had memory problems you might not notice it being worse after surgery.

Language

The left temporal lobes are important for aspects of language. People with epilepsy sometimes struggle to find the word they are looking for. This could get worse after surgery for temporal lobe epilepsy.

Mood

It’s usual to have a dip in mood soon after surgery. This might be more likely if you have had low mood, anxiety or depression in the past. Normally this will improve over a few weeks or months. But if it affects you for longer, talk to your epilepsy surgery nurse or doctor, to see how they can help you.

What might the benefits of epilepsy brain surgery be?

These are some possible benefits:

  • No more seizures
  • Fewer or less severe seizures
  • Lower risk of injury and SUDEP (Sudden Unexpected Death in Epilepsy)
  • Better quality of life
  • Less need for epilepsy medicines

What if epilepsy brain surgery is not for me?

Some people who can’t have epilepsy brain surgery may be offered different types of surgery to help with their seizure control. These include vagus nerve stimulation and deep brain stimulation. Your epilepsy specialist will be able to tell you more about these surgeries.

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 see the Oxford University Hospital’s or the Walton Centre’s surgery information.
  • 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, please contact Epilepsy Action Info_Requests_Helpline

Code: 
F062.05

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.

  • Updated May 2022
    To be reviewed February 2023

Comments: read the 1 comments or add yours

Comments

In 1974 until 1976, I was one of the first 100 epileptics to undergo this treatment at Oxford.
My surgeon, a Mr CBT Adams FRCS Mchir, and his team ran the pioneering project. On 12/02/1976, Friday 13th that year, I underwent surgery. All was fine until 5 weeks and 6 days after surgery, I got up and felt off colour. So took my normal medication, and one of the headache pills. First one for weeks. Well I went back to bed and awoke in Oxford Radcliffe Infirmary, with Drs and nurses I knew. I had contracted a bone infection. But soon medicated and in 6 days was home. Since never any issue, only the manner in which the working life was affected, due to this.
What we can't see, we are afraid of, as a human.
Should you be offered neuro surgery, go for it. In my case none of these smart scans were around. So I was shaved and a Bowater flap cut, to access ones skull. I would be only too happy to share my experience to ensure anyone unsure, can talk to a well and fit person who was one of the first, to undergo this surgery.

Submitted by DOUGLAS KEITH MORGAN

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