Epilepsy Surgery

The words “brain surgery” frighten most families. Yet in carefully selected patients, epilepsy surgery is a life-changing treatment that can end seizures completely. This chapter aims to help you weigh surgery with knowledge rather than fear.

Who Is Surgery Considered For?

Epilepsy surgery is considered mainly for children who have drug-resistant epilepsy and whose seizures come from a specific, well-defined area of the brain. The goal is to remove the brain area that causes the seizures (the seizure focus) while protecting important functions (such as speech, movement, and vision), or to prevent seizures from spreading.

A Careful Assessment Before Surgery

The decision to operate is never made in a hurry. Beforehand, a thorough assessment is carried out: identifying the seizure focus with video-EEG, a detailed MRI, functional imaging, and neuropsychological tests. These assessments aim to answer two key questions: Do the seizures come from a single, removable area? and Will the child's vital functions be preserved once that area is removed? If the answers to these questions are yes, surgery becomes a strong option.

Types of Surgery

• Resective surgery: Removing the seizure focus. In suitable patients, the rate of seizure freedom is quite high.
• Disconnection surgery: Cutting the pathways along which the seizure spreads (for example, in some severe one-sided cases).
• Palliative surgery: When it isn't possible to stop seizures completely, procedures that aim to reduce the most harmful seizures, especially drop attacks (for example, corpus callosotomy).

Two important truths about surgery

In carefully selected children, surgery can completely end seizures that have lasted for years, and can dramatically improve a child's development, school achievement, and quality of life.

Thanks to the flexibility of the child's brain (neuroplasticity), children recover far better after surgery than adults do. That's why, in suitable cases, it's important not to delay surgery.

Every surgical procedure carries its own risks, and these risks are discussed with you in detail at an experienced epilepsy surgery center. The decision is made through the shared assessment of the family, the child (when appropriate), and the whole team. Considering surgery doesn't mean saying “we've tried everything and we're out of options”; on the contrary, it means putting the most effective option on the table.