Epilepsy surgery: your overview

There are many treatments available for epilepsy today. One approach is to use surgery. 

Epilepsy surgery is normally only an option if you have drug-resistant epilepsy (when you’ve tried two or more appropriately chosen anti-seizure medications without achieving seizure freedom). Having surgery may be an alternative way of treating your seizures.

If you’re interested in exploring whether surgery might be right for you, speak with your doctor. This article is for informational purposes only and is not medical advice. 

Resections and other kinds of surgery

Often, when people talk about brain surgery for epilepsy, they’re talking about resections, which is when the skull is opened up and a part of the brain is removed. This is the most common kind of epilepsy surgery. But there are also other surgical methods that can be used to treat epilepsy too.

What is epilepsy surgery?

Epilepsy surgery includes a few types of surgery that are intended to stop or reduce the number of seizures people have. A brain surgeon will perform different operations, depending on the individual’s needs and the cause of their seizures. 

There may be different goals for epilepsy surgery, including:

• Achieving seizure freedom (no more seizures) 
• Improving the individual’s quality of life or development
• Being able to stop or decrease the amount of anti-seizure medications they take

Epilepsy surgery is often done at a specialized epilepsy center. Experts at these centers do tests to decide if surgery would be suitable for the individual patient. The expert then selects the type of surgery that would be most appropriate for the patient. 

If you are thinking of having epilepsy surgery, the treatment team at the epilepsy center can answer all your questions. 
Learn more: How to find doctors who specialize in epilepsy?

Who can have surgery for epilepsy?

Epilepsy surgery may be an option for some people with epilepsy, but it’s not suitable for everyone. 

According to the American Association of Neurological Surgeons, epilepsy surgery is mainly recommended for:

• People with drug-resistant epilepsy, which is when anti-seizure medication does not stop their seizures
• People with focal epilepsy, which is when seizures start in one specific area in the brain (although certain types of surgery can help some people with generalized seizures, which affect both sides of the brain from the start)
• When the part of the brain that’s causing seizures can be removed or separated safely without a high risk of complications

In a 2019 journal article, one expert pointed to evidence showing that epilepsy surgery is underutilized - which means more people with drug-resistant epilepsy could benefit from this treatment. 

Read more: What is drug resistant epilepsy? 

Common kinds of epilepsy surgery

Below, you will find an overview of different surgical procedures that can be used to treat epilepsy. You will also find some information about epilepsy surgery success rates. It’s important to remember that these are general statistics intended to give you an idea of effectiveness. The outcomes for particular individuals will vary. 

Brain resection surgery

When doctors and epilepsy specialists talk about epilepsy brain surgery, they’re often referring to resections. This is by far the most common type of epilepsy surgery.  

In a resection, the part of the brain that is causing the seizures (known as the seizure focus) is removed. There are different kinds of resections:

• Lobectomy: Each half (hemisphere) of your brain is formed of four sections called lobes. In a lobectomy, the lobe where the seizures start is removed. 
• Lesionectomy: Sometimes seizures are caused by abnormal growths in the brain called lesions. A lesionectomy is a kind of resection where the lesion is removed. 
• Amygdalohippocamectomy: This is a type of resection used to remove parts of the brain called the amygdala and hippocampus.

By far the most common kind of resection surgery is a temporal lobectomy. Data from the years 2000-2013 found that 59% of all surgical procedures used to treat epilepsy in North America were temporal lobectomies. 

In one analysis of 241 patients who received temporal lobectomy, 73% became free of disabling seizures, an almost 59% experienced seizure freedom.

Other kinds of surgery for epilepsy

Several other kinds of surgery have been developed to treat certain kinds of epilepsy. These methods are less common, but might be a suitable option in certain circumstances.

Multiple Subpial Transections (MST) 

In multiple subpial transection (MST) surgery, the surgeon makes fine, shallow cuts in the brain’s gray matter. This is believed to stop how seizures spread. 

Hemispherectomy

During a hemispherectomy, the surgeon separates one half of the brain from the other. Removing connections between the two sides (‘hemispheres’) of the brain can help with seizure control. Hemispherectomies are mainly offered to children. 

Corpus callosotomy

A corpus callosotomy is an epilepsy surgery that’s mainly used to treat people with a type of generalized seizure called atonic seizures or ‘drop attacks’. It works by dividing the corpus callosum, a part of the brain that lets electrical activity flow from one side to the other. 

Laser Interstitial Thermal Therapy (LITT)

With Laser Interstitial Thermal Therapy (LITT), a tiny hole is made in the patient’s skull. Then, a laser is targeted at the focus of the seizures which destroys it. LITT is a non-invasive form of surgery, as the patient’s skull does not need to be opened up.

Stereotactic radiosurgery

With stereotactic radiosurgery, a beam of radiation is targeted at the part of the brain causing seizures, which destroys it. This type of surgery is non-invasive. The skull does not have to be opened because the radiation can pass through from the outside. 

Neuromodulation

Neuromodulation is another kind of treatment for epilepsy. For implantable neuromodulation, a device is implanted in your body which sends electrical signals to the nervous system. 

Although some of these involve surgical implantation into the body, and some into the brain, the surgical procedures are very different from the epilepsy brain surgeries discussed above. 

If you’re interested in neuromodulation devices for epilepsy, speak to your doctor. You may also wish to read this overview of implantable neuromodulation devices for epilepsy.

Can epilepsy be cured by surgery?

For some people, surgery can lead to seizure freedom. If the surgery is successful, it may mean they can stop taking their medication and remain seizure free. But this isn’t the case for everyone. 

For some people, surgery can greatly reduce the number of seizures, but seizures may still occur. For others, surgery may not lead to meaningful improvement and, like any procedure, may carry a risk of complications. 

Talk to your doctor about epilepsy surgery side effects, risks and recovery.

Epilepsy surgery - an option to think about

Brain surgery for epilepsy is not an option for everyone. However, for people with drug-resistant epilepsy, it may be worth discussing with your doctor. If it may be a good option for you, your doctor may refer you to a specialized epilepsy center for further testing.