There are a number of factors that need to be taken into account before it is possible to say whether or not brain surgery is an option.
Surgery can be considered if:
- Several anti-epileptic medications have been tried and have not led to seizure freedom;
- The seizures arise from one brain region;
This brain region is accessible to surgery and can be removed without seriously damaging important functions such as language, strength and vision;
The chances of becoming seizure free after surgery are reasonable.
Sometimes epilepsy can be caused by a structural problem in the brain. This may have been present from birth, and manifests itself later in life with seizures, or may be caused later in life because of an injury to the brain such as trauma, stroke, a tumour or infection. If test results show that the seizures appear to be arising from this particular area, brain surgery may be a good option.
About 1 in 5 people with seizures arising from one area of the brain have normal MRI brain imaging. If all other tests point to the same brain area, surgery may also be possible. Often, more tests, including brain imaging tests, or more EEG tests are needed.
In a few people EEG recordings may need to be performed directly from the brain. Such recordings may help if a general area of the brain is suspected of being the cause of the seizures, but more precise information on where seizures may start is needed. This is called intracranial EEG recordings.
In some very young children with an abnormality seen on one side of an MRI scan, referral for assessment may occur prior to a full trial of two anti-epileptic drugs.
Some additional individuals with epilepsy associated with a congenital weakness down one side (Hemiplegia) may also be suitable for surgery.