Even though medicine is the most common approach to treating epilepsy, it does not always work. In almost one-third of people with epilepsy, medicine cannot control their seizures adequately (or at all, in some cases). This number is even higher in people with focal epilepsy. Surgery can greatly improve the lives of some people who have epilepsy.
You may be a good candidate for surgery if your seizures:
Fifty percent of all patients with newly diagnosed epilepsy will become seizure-free with the first epilepsy drug they try. For the rest, it's try, try again: switching epilepsy medications, adjusting to side effects, and waiting to make sure the new drug works. Others find their seizures are controlled, but they can't tolerate the medication's side effects and need to switch drugs.
Before you ask your doctor if your medication should be switched, make sure you are taking your current medication...
Tend to result in injury or harm (for instance, if seizures cause frequent falls).
Change or alter your consciousness.
Are not controlled well with medicine, or you cannot tolerate the side effects of the medicines.
Having frequent or severe seizures often restricts you from driving, doing certain kinds of work, and other activities. Medicine may fail to control these seizures. Or medicine may cause side effects severe enough to disrupt your lifestyle.
Surgery is not an "if all else fails" approach to treating epilepsy. It often may be a better choice than trying each and every medicine. For adults with temporal lobe epilepsy, for instance, surgery may be considered if two different first-line medicines are tried and neither controls the seizures adequately. For certain types of childhood epilepsy-disorders that children cannot outgrow and that do not respond to medicine-having surgery at the youngest possible age may offer the greatest benefit for the child. The younger brain is more adaptable and recovers better after surgery.
Epilepsy surgery removes an area of abnormal tissue in the brain, such as a tumor or scar tissue, or the specific area of brain tissue where seizures begin. Before surgery, you may have several tests (including an electroencephalogram [EEG], magnetic resonance imaging [MRI], and video monitoring) to find exactly where seizures begin in the brain. After the area of abnormal tissue where your seizures begin has been located, doctors can decide whether or not it can be removed safely.
Surgery is usually done in a hospital that is associated with an epilepsy center. The surgery usually takes a few hours, and you have to stay in the hospital for a few days afterward. It may be several months or more before you feel fully back to normal.