Epilepsy surgery is reserved for people whose seizures are not well controlled by seizure medicines. This situation is sometimes called being "medically refractory" or "drug resistant." 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.
Who may be eligible for epilepsy surgery?
Surgery is an elective procedure done in people who have had extensive testing to decide if they are potential candidates. The following criteria are considered when determining if a person may be a good candidate for surgery.
- Person has failed 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 combination of at least two drugs.
- 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.
- 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 a medication is helping.
- 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 the past if it seems appropriate for that person.