Once you are being considered for epilepsy surgery, you will have to undergo three major steps

• Pre-surgical evaluation
• Consensus decision and
• Finally Surgery

In pre-surgical evaluation, we decide the exact parts of your brain which is responsible for this epilepsy with various tests, clinical evaluations etc. And a team of doctor specialists from various related fields meet together to discuss and reach a consensus about the type of surgery you will need. A final plan is decided in the multidisciplinary meeting.

Pre-surgical evaluation consist of various domains. Most important is video EEG followed by investigations like MRI, PET scan, SPECT scan. This MRI scan done here is not the routine MRI but customized scan which will depend on your video EEG recordings. Neuropsychological evaluation is also a crucial part of presurgical evaluation which provide important insight about the localization and possible problems you will be having after surgery. Once all these investigations are ready, it is generally discussed in meetings to reach a consensus about the plan.

Epilepsy surgeries are mainly of two types. In patients where we find a small, focal brain area responsible for epilepsy, we go for resection of that area. These surgeries are called curative surgeries where once that area is removed; patient will be mostly free of epilepsy. However, there is a group of patients in which a large area is responsible or we could not define a small area or removing complete area is not feasible; surgeries are meant to just reduce seizure frequency and improve quality of life. These surgeries are called palliative surgeries.

Chances of seizure control depend on many variables and varies between 50-90%. If MRI shows some lesion which could be completely removed, then 9 out of 10 people can achieve seizure freedom and almost 6 out of 10 patients can be off medicine. However, outcome is in the magnitude of 50% with palliative surgeries. Outcome typically depends on the responsible pathology.

Epilepsy surgery is a carefully planned procedure, carried out under optimal circumstances to remove the region of brain causing the seizures, and to spare parts of the brain necessary for everyday functions.

Complications are very infrequent in epilepsy surgery, major complications like motor deficits, language deficits, vegetative states and disabilities are seen in 3-5% of cases. Other treatable complications like infections, prolonged hospitalizations, transient deficits, speech problems, mood problems, visual field deficits are common and do not alter the normal daily life. Overall, epilepsy surgery is safe surgery and it improves quality of life of many patients and their care takers significantly.

We recommend continuing the medication for at least two years, subsequent to which medications can be reduced and even stopped in certain cases where the seizures are well controlled.