Neurosurgical Treatments
Epilepsy: When Is Surgery Considered?
When seizures continue despite trying medicines properly, epilepsy surgery may be an option for selected patients. How evaluation works and what to expect.
A 19-year-old engineering student from Ballabhgarh has had seizures since the age of twelve. He has tried three different medicines at proper doses, yet still has episodes where he stares blankly, smacks his lips and loses a few minutes of awareness. He cannot drive, avoids swimming and worries about fitting in at college. His neurologist suggests an evaluation for epilepsy surgery. His parents are startled: surgery for fits? For a carefully selected group of people with epilepsy, surgery is a recognised option worth understanding.
Key takeaways
- Most people with epilepsy are managed with medicines led by a neurologist.
- Drug-resistant epilepsy means seizures continue despite two appropriate medicines at adequate doses.
- Surgery suits selected patients whose seizures arise from one identifiable, safely treatable area.
- Detailed evaluation, including video-EEG and specialised MRI, comes before any decision.
Most epilepsy is managed with medicines
Epilepsy is a tendency to have repeated seizures due to abnormal electrical activity in the brain. Care is usually led by a neurologist, and many people become seizure-free with the first or second suitable medicine. Taking medicines regularly, sleeping enough and avoiding alcohol all help. Surgery is not considered unless medicines have been given a fair chance.
What is drug-resistant epilepsy?
Epilepsy is generally called drug-resistant when seizures continue despite trying two appropriate medicines at adequate doses. Before using this label, doctors check that the events really are epileptic seizures (some are fainting episodes or non-epileptic attacks), that medicines have been taken regularly, and that the right medicine was chosen for the seizure type. Once epilepsy is truly drug-resistant, the chance that further medicine changes will stop seizures is lower, so referral for a surgical evaluation is reasonable.
Who may be a candidate for surgery?
- People whose seizures start from one identifiable area of the brain (focal epilepsy)
- Where that area can be treated without unacceptable loss of speech, movement, vision or memory
- Those with a visible cause on MRI, such as scarring of the hippocampus, a tumour, a cavernoma or an area of abnormal brain development
- People whose seizures significantly affect safety, education, work or independence
Age is not by itself a barrier, and evaluation does not commit anyone to an operation. Some people complete the full assessment and are advised that surgery would not be safe or helpful; their treatment then continues with medicines or other approaches, guided by the detailed testing already done.
The pre-surgical evaluation
Evaluation is a team effort involving a neurologist, neurosurgeon, radiologist and neuropsychologist. It may include:
- Video-EEG monitoring, a hospital stay in which seizures are recorded on camera and EEG together
- A high-resolution MRI using an epilepsy protocol
- PET or SPECT scans in some patients
- Memory and language testing
- In complex cases, functional MRI or EEG electrodes placed inside the skull
The aim is to pinpoint where seizures begin and judge whether surgery can be done safely.
Types of epilepsy surgery
Resective surgery removes the area causing seizures, for example in temporal lobe epilepsy or when a lesion is present. Disconnection procedures interrupt the spread of seizures in selected patients. Neuromodulation, such as vagus nerve stimulation or deep brain stimulation, aims to reduce seizure frequency when removal is not possible. Epilepsy surgery and deep brain stimulation are among Dr. Naresh Panwar's listed areas of work; the exact technique for any patient is decided by the treating team. See epilepsy surgery and deep brain stimulation.
When this is an emergency
Call 112 if a seizure lasts more than five minutes, if seizures repeat without the person waking in between, if it is a first-ever seizure, if the person is injured, pregnant or has trouble breathing, or if the seizure happened in water. During a seizure, turn the person on their side, cushion the head and never put anything in their mouth.
Benefits, risks and life after surgery
For well-selected patients, surgery may reduce seizures substantially or stop them, and some people can later lower their medicines. Risks depend on the brain area involved and may include infection, bleeding, and changes in memory, language or vision; some patients continue to have seizures. Most people continue medicines for a period afterwards, and driving rules apply. Families in Faridabad and nearby areas can book a consultation at Sarvodaya Hospital, Sector 8 to discuss whether an evaluation is appropriate.
Frequently asked questions
Will I be able to stop medicines after epilepsy surgery?
Not immediately. Most people continue medicines for a period after surgery. If seizures remain controlled, the neurologist may gradually reduce them in some patients.
Kya mirgi ka operation safe hai?
Every brain operation has risks, which depend on the area involved. A thorough pre-surgical evaluation is done precisely to judge whether the expected benefit outweighs the risks for each person.
Is epilepsy surgery only for adults?
No. Children with drug-resistant epilepsy may also be evaluated, and early assessment can matter for development and schooling. Decisions are made by a specialised team.
This article is general health information for patients and families. It is not a diagnosis. Please consult a qualified doctor about your own symptoms. See our medical disclaimer.
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