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.
There are several different types of epilepsy surgery. These include brain surgery, deep brain stimulation and vagus nerve stimulation.
Why is epilepsy brain surgery done?
Overall, the aim is to improve your quality of life.
Will I benefit from brain surgery?
You might benefit from epilepsy surgery if you have tried a number of epilepsy medicines and are still having seizures. Your epilepsy will also have to be of a type that can be treated with surgery. Unfortunately, sometimes surgery is not possible.
There are various different types of epilepsy brain surgery.
If you are being considered for epilepsy surgery, your doctors will talk to you about the tests and type of surgery you will have.
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.
In video telemetry, a video recording is done at the same time as the EEG. This means that if you have a seizure, doctors can see exactly what happens. It is important that everyone who may benefit from surgery has video telemetry. This is to find out exactly where in the brain your seizures are coming from. An EEG/video telemetry can be done while you are awake or asleep, or both.
An MRI scan uses a strong magnetic field and radio waves to create 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.
These activities increase the flow of oxygen-rich blood to a particular part of the brain. From these activities it will be possible to see which part of your brain manages important tasks such as thought, speech and language, movement and sensation.
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.
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 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.
There are 2 sorts of SPECT scans: one is the inter-ictal and the other is the ictal. Ictal means seizure, so the ictal SPECT scan is done just after you have had a seizure. 'Inter' means between, and so the inter-ictal SPECT scan is done between seizures.
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.
These are tests that show if you have any memory or learning problems. They can take up to 6 or sometimes 8 hours, split into 2 or 3 different sessions, and involve a number of games and puzzles. The results of the tests may help the surgeon in planning the type of surgery you might need. The results can also show whether the part of your brain that will be operated on is responsible for any 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.
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.
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. The reason for invasive EEG telemetry is to find out where exactly your seizures are coming from. Another part of this test is called 'cortical mapping'. This is to reduce the risk of any complications after surgery, when the neurosurgeon removes the part of the brain causing the seizures. These complications can include a loss of speech or paralysis down one side of the body.
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 the operating team locate the part of your brain that controls language and movement. Your surgeon will be able to explain this to you. After the surgery, the bone is replaced, and fixed to your skull for healing. Epilepsy brain surgery usually takes several hours.
Will my seizures stop after surgery?
The chances of being seizure-free after surgery varies from person to person. Among other things, it depends on the type of epilepsy surgery, scan findings and whether all the information from tests fit together. Your doctors will be able to tell you more about the expected success rate of your surgery. They will also be able to tell you about any complications that could happen following your surgery.
What are the possible surgery outcomes?
As well as brain surgery, there are other types of surgery that can help some people with ongoing seizures.
Vagus nerve stimulation (VNS) is a treatment where your vagus nerve is stimulated to stop your seizures. The surgery involves having a small generator that is implanted under the skin below the left collarbone. This is connected to a lead with 2 coils at one end. These coils are wrapped around the vagus nerve at the side of the neck, under the skin, during a small operation.
Deep brain stimulation (DBS) is a treatment where a part of the brain is stimulated, to stop seizures. The surgery involves having a DBS system fitted.
1. A lead – this is a thin, insulated wire. It is placed in the part of the brain where the seizure activity happens, through a small hole in the skull.
2. A neurostimulator – this is a small device, similar to a heart pacemaker. It is usually placed under the skin near the left collarbone, lower in the chest, or under the skin of the stomach.
3. An extension – this is an insulated wire that is passed under the skin of the head, neck, and shoulder. It connects the lead to the neurostimulator.
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.
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.
I was wondering I have had it basically all my life as my dad has it and I have it can the surgery be to anyone who has it or is it not possible ?
Surgery would only be considered for someone if they had taken a number of different medicines and none of them had worked.
This could either be if the person was still having seizures or if the side-effects of the medicines were too difficult to tolerate.
Then the doctors would need to do a large number of tests to see if the person was suitable.
Hopefully the information on our surgery page will help you to make a decision about whether it would be a good idea to talk to your neurologist about this.
I'm 18 and I've had epilepsy for 4 Years, I have tonic clonic and focal sezuire. I have tried 3 different types of medication and they all worked for 2 weeks then stopped. Lemotragine made me put on weight but later it dropped off.At one point keppra made the focal seizure so much worse because it was too high dose for me and doctor apologied for not believing me when I said all this. It affected my behaviour horrendously. Carbamazepine has made no difference whatsoever to my epilepsy but I still am having to take the dose still I'm at the maximum I can take. It has given it me severe social anxiety and all throughout school and now work which I have only been doing 6 months; I'm worried it is going to cause me to leave work. I have tried therapy to help this anxiety but not a lot of difference. Over the past 4 year it has got increasingly worse. I was wondering would I have a chance in qualifying for surgery and what ones are there?
That sounds like a really tough situation for you.
Surgery is only suitable for some people. But as you have had such a difficult time with the epilepsy medicine and you are still having seizures it is certainly worth thinking about a second opinion. This would mean you had a complete epilepsy review and a consideration of what other options there might be for you. If appropriate these should include VNS and surgery. We have information on our section on getting the right treatment and care for your epilepsy. It's called What if my seizures are difficult to control?
You might also want to look at our information on stress and on epilepsy and work.
If it would be any easier to talk to us on the phone, please feel free to contact us again on the Epilepsy Helpline freephone 0808 800 5050.
i have grandmal seizures, recently started having them in clusters, i am now 28 and been on medication since i was 14 and none seems to work. i also have a vns but that does not control seizures. I also have no warning of a seizure do you think i would be able to have surgery?
That sounds like a tough situation if nothing is working to give you seizure control.
Usually you would only be offered VNS if you are unsuitable for surgery. But there is certainly no harm in checking that out.
I wonder if anyone has talked with you about the ketogenic diet? It can be really hard to tolerate, but can make a difference to seizure control for some people.
You might also want to look at our information on getting the right treatment and care for your epilepsy. Maybe a full epilepsy review or a second opinion would be helpful? The information I have linked you to gives some guidance on this.
I have partial fits nearly every week my epilepsy is caused by three blood veins abnormal both sides of my temple would you operate on both sides of my temple lobes?