What is epilepsy surgery?

Epilepsy surgery is a treatment used to help control seizures when seizures are not controlled by medications.

Epilepsy surgery is “neurosurgery,” which means it is surgery involving the brain. Doctors who do epilepsy surgery are neurosurgeons. Neurosurgeons who specialize in the care of people with seizures are found at comprehensive epilepsy centers.

There are many different types of epilepsy surgery. The type of surgery recommended will depend on many factors. The key factors are the type of seizures and where they start in the brain.

  • Epilepsy surgery works best for people who have seizures that always begin in one area of the brain.
  • Tests are done before surgery. This testing helps to find the area in the brain where seizures start. The tests also help to make sure the area where seizures begin is not involved in important brain functions that include speech, movement, or memory.
  • Epilepsy surgery can reduce the number and severity of seizures a person has when compared to only taking medications.
  • By removing the seizure focus in the brain, epilepsy surgery can, in most cases, successfully and safely stop seizures. Some people may need a second surgery to become seizure free. Although many people are permanently seizure free after surgery, seizures can come back in some people.

How long has epilepsy surgery been available?

Surgery for epilepsy has been used to control seizures for more than 100 years.

  • Since the 1980s and 90s, epilepsy surgery has become a standard of care for certain people when medicines don't work. The number of comprehensive epilepsy centers has increased in the United States, making it possible for more people to get specialized epilepsy care.
  • Technology has improved the ability to find where seizures begin in the brain. This helps medical teams decide who may benefit from surgery.
  • Research has shown that in some people surgery can be a more effective treatment than anti-seizure medications and may be the treatment of choice.
  • One study compared two groups of people with epilepsy who did not respond to anti-seizure medications. One group had epilepsy surgery, and the other group continued taking seizure medications. This study showed that approximately 6 out of 10 people who had surgery were able to be free of disabling seizures. In comparison, approximately 1 out of 10 people who continued taking medicine without surgery were seizure free. 
  • The safety of brain surgery is better now than years ago. Technology has made it easier to map the brain to protect areas involved in speech, movement, and memory during surgery.
  • More recently, ways to do epilepsy surgery (LITT and stereotactic radiosurgery) without opening the skull have been used in some people.

What actually happens during surgery?

Currently, most cases of epilepsy surgery involve removing the area where seizures start. Typically, this involves creating an opening in the skull (the bone covering the brain) in a procedure called a craniotomy.

  • Epilepsy surgery usually takes several hours.
  • The person’s hair may be clipped short or the head shaved in the area where surgery will be done. This lessens the risk of infection.
  • Anesthesia is given so the person is asleep and not aware during the surgery.
  • Just like any surgery, heart rate, blood pressure, and oxygen levels are checked closely.
  • A small part of the skull is opened so the surgeon can see the area of abnormal tissue to be removed.
  • EEG (electroencephalogram) monitoring may be done during the surgery. This will confirm exactly where in the brain the seizures start and what area needs to be removed.
  • In some cases, the person is woken up during the surgery so he or she can talk and respond to questions. This helps the surgeon test which areas of the brain control speech or movement. This is important to lessen the risks of these areas being affected during surgery. This part of the surgery is called “brain mapping.”
  • Once the brain areas are mapped, the anesthesiologist will return the person to sleep with medication, and the neurosurgeon can safely remove the abnormal brain tissue causing the seizures.
  • The piece of bone that was removed from the skull at the beginning of the surgery will then be secured back in its normal position. The skin overlying the skull is then closed, and a head bandage is applied.

What happens after surgery?

  • Right after surgery, the person will be in a special recovery unit where the doctors and nurses will monitor you very closely as you wake up from anesthesia.
  • Depending on the hospital, a person may spend the first night after surgery in the intensive care unit for close monitoring or may go directly to the neurosurgery or epilepsy unit.
  • In the first week after surgery:
    • Some swelling of the scalp and face is usually seen. This is normal as the tissue will need some time to heal from the surgery.
    • Headaches are also common.
    • Medicines to treat these symptoms will be given.
    • For most people, the swelling and head pain after surgery goes away within a few weeks.
  • Typically, people spend 3 to 4 days in the hospital after surgery. In some cases, a longer stay in the hospital is needed.
  • Usually, people can go home to recover. If a person needs more help or lives alone, they may go to a rehabilitation facility for a short time until they are ready to go home.
  • A person recovering from surgery needs to rest and slowly return to their normal daily routines.
    • Activity is gradually increased.
    • Most people are back to their usual activities in 4 to 6 weeks. 
    • There may be some restrictions or precautions depending on each person’s situation.
  • Seizure medicines are continued after surgery. Medicine helps to protect the brain during the healing and increases the person’s chances of being seizure free later on.
  • If a person is seizure free after a year or more, medicines may be gradually lowered or tapered off.
  • Changing medicines slowly may help the person’s chances of staying seizure free.
  • Each person should talk with their epilepsy team about what is best in their situation.
  • There are other steps to consider in recovering from brain surgery.
  • One of the goals of epilepsy surgery is to improve a person’s quality of life. This may include support from a therapist, vocational counselor, social worker, physical or occupational therapist, or neuropsychologist. 
  • Contact your local Epilepsy Foundation or call the Epilepsy & Seizures 24/7 Helpline at 1-800-332-1000 (en Español 1-866-748-8008) to find out what other help in your community is available.
  • Finding support as you adjust to changes after surgery is an important part of your recovery.
  • Remember, your epilepsy team will be there to support you through all stages leading up to surgery, during surgery, and recovery.

Where can I learn more?

There are several different types of surgery available today. To find out if you are a candidate for surgery and which type is best, speak with your doctor.

  • Ask your primary care doctor for a referral to a specialized epilepsy center that offers surgery as a treatment for epilepsy. This is called a Level 4 Comprehensive Epilepsy Center.
  • You will need to have many tests (called a pre-surgical evaluation). Different medical specialists will be involved as you explore the possibility of surgery as a treatment for your epilepsy.
  • Include your family, a supportive friend, or caregiver as you think about whether surgery is right for you. It is important to make the decision about surgery together with those people who know you best.
  • Surgery for epilepsy is very rarely done in an emergency.
    • Your epilepsy team may recommend surgery to you based on the results of the tests done as a part of your pre-surgical evaluation.
    • It’s an elective procedure. That means you (the person with epilepsy) with your family and supports will make the decision about whether to have surgery.
    • You will have many chances to talk about the recommendations you receive and to ask questions of your epilepsy team. 
    • If you decide to have surgery, your epilepsy team will help prepare you and your family. 
  • Working together with your epilepsy team is the key to understanding your epilepsy and the best treatment options for you.
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Authored By: 
Elaine Kiriakopoulos MD, MSc
Authored Date: 
10/2018
Reviewed By: 
Mohamad Koubeissi MD
Sandra Dewar RN, MS
on: 
Monday, October 15, 2018