Epilepsy surgery is reserved for people whose seizures are not well controlled by seizure medicines. (This situation is sometimes called being "medically refractory.") In the past, epilepsy patients were referred for surgery only after they had taken medicine after medicine without success, often for 10 years or more. Today, however, the definition of medically refractory has changed, and surgery is being performed as early as 1 to 2 years after the diagnosis of epilepsy is first made.

In children, the definition of medically refractory is even more individualized to the specific child's situation. Surgery may be considered for some children after weeks to months of treatment with seizure medicines.

In general, a person is considered to be a potential candidate for surgery if adequate trials of two first-line seizure medicines (ones that are commonly effective in controlling the type of seizures the person is experiencing) and one two-drug combination all have failed to control the seizures. A trial of a medication is considered adequate when it has been increased gradually to the maximum dosage that does not cause serious side effects and then is given for a long enough period. If the person has frequent seizures, any improvement will be obvious after a short time. If the seizures generally occur far apart, however, it may take months to determine whether the time between seizures is increasing.

At some epilepsy centers, patients are offered additional conventional or experimental medications before surgery is considered. But research suggests that each time a trial of medication fails to control a person's seizures, it becomes less likely that a different medicine or combination will be successful. Since uncontrolled seizures present serious physical risks and social and psychological consequences, the trend these days is to proceed with surgery much sooner than in years past if it seems appropriate for that person.

Topic Editor: Howard L. Weiner, M.D.
Last Reviewed:3/8/04