Epilepsy surgery is a localization and network decision
Surgery is considered when seizures persist despite appropriate antiseizure medicines and a removable or disconnectable seizure-onset zone can be identified.
Evaluation combines seizure history, prolonged video EEG, epilepsy-protocol MRI, neuropsychology and sometimes PET, SPECT, MEG or intracranial EEG. The evidence must be interpreted together.
A visible MRI lesion is not automatically the seizure source, and a normal MRI does not exclude a surgically treatable epilepsy.
Who may be considered?
Specialist review may help when the diagnosis, symptoms and previous treatment create a focused question about epilepsy surgery evaluation.
- Focal seizures persisting after appropriate medication trials.
- A structural lesion with electroclinical evidence of seizure onset.
- Disabling drop attacks or network epilepsy considered for disconnection.
- A patient unsuitable for resection who may benefit from neuromodulation.
What the specialist team must confirm
The epilepsy team reviews seizure semiology, medication history and adherence, video EEG, epilepsy MRI, neuropsychology, language and memory dominance, psychiatric health, PET or other functional imaging and the potential need for invasive monitoring.
Key points for this treatment
From recorded seizures to a testable surgical hypothesis
When non-invasive data are insufficient, intracranial electrodes may be used to refine onset and functional boundaries.
Seizure outcome and function are followed over years
Early care monitors seizures, mood, cognition and neurologic function. Antiseizure medicines are usually continued initially.
Long-term follow-up uses seizure diaries, EEG when needed and neuropsychological or rehabilitation support. Medication reduction is individualized and gradual.
Risks, limits and realistic expectations
Risks include bleeding, infection, stroke, weakness, language or memory decline, mood change, visual-field loss, persistent seizures and death. Surgery cannot guarantee seizure freedom.
A seizure lasting five minutes, repeated seizures without recovery, serious injury, breathing difficulty or new persistent weakness requires emergency local care.