What Types of Surgery Help Treat Epilepsy?

Medically reviewed by Brigid Dwyer, MD

Epilepsy surgery may be a treatment option for those experiencing difficult-to-treat seizures or drug-resistant seizures. While there are many medications available for the treatment of epilepsy, not everyone may find success with medications. Among people taking epilepsy medications, only will 44% report being seizure-free in the past year.

Fortunately, surgical treatments for epilepsy have expanded in recent years. There are now more options than ever to intervene and treat epilepsy in adults and children. In this article, learn about when to consider epilepsy surgery, the different types of surgery, and how to evaluate if you may be a candidate for surgery.

Epilepsy Surgery

Deciding whether you will be a good candidate for epilepsy surgery includes weighing the risks and benefits. Your healthcare team will assess your condition and provide options.

Benefits of Surgery

Surgery for epilepsy is beneficial because it can enable better control of seizures. Some people are able to live a life free from anti-seizure medications. A sense of greater control over your condition can also be a benefit.

When Is Surgery the Right Option?

Any surgery that involves the brain is a major procedure and requires serious evaluation beforehand. In most cases, surgery is used when anti-seizure medications are not working. If you have tried different medications for seizures or experienced side effects from medications, then surgery may be an option for you to explore.

Presurgical Testing

The most necessary tests to have before undergoing epilepsy surgery are the same tests used to evaluate the severity of epilepsy. If you have a diagnosis of epilepsy, your healthcare provider may order tests such as an electroencephalogram (EEG) and magnetic resonance imaging (MRI) to evaluate the extent of your epilepsy in more depth.

In some cases, advanced imaging tests like positron-emission tomography (PET) scans and single-photon emission computerized tomography (SPECT) scans can be used to visualize the specific regions of the brain that are involved when you experience a seizure.

In addition to epilepsy-specific tests, your healthcare provider may also perform a series of pre-procedure blood tests to ensure you can safely undergo surgery. 

Neurostimulation

Since seizures are caused by abnormal electrical activity in the brain, treatments that focus on changing or modulating the electrical flow in the brain have been developed. Neurostimulation is a form of therapy that uses tiny wires called electrodes to send signals through the nervous system. Different devices have shown benefits for treating epilepsy.

Vagus Nerve Stimulation

The vagus nerve is one of the main nerves that connects the brain to organs like the heart, stomach, and other major organs. In vagus nerve stimulation, an implanted electrical stimulator is placed inside the body and sends regular pulses of electrical signals through the vagus nerve to help control seizures.

The effect of these extra signals is not well known, but they are thought to help reduce seizures through several mechanisms, such as changing blood flow within the brain or increasing certain neurotransmitter levels (chemical messengers between nerve cells).

Deep Brain Stimulation

Deep brain stimulation is a form of therapy in which electrodes are placed in specific areas of the brain and connected to a small battery that is similar to a pacemaker. The device is programmed by your healthcare provider during the operation and sends regular signals to the brain in an attempt to regulate brain activity and control seizures.

Deep brain stimulation can help reduce seizures in about half of the people who have the procedure. It may also reduce seizure severity.

Responsive Neurostimulation

Responsive neurostimulation uses an electrical stimulator that can sense the region of the brain that is activated during a seizure and attempt to turn it off.

The responsive neurostimulator is implanted along with electrodes that can sense electrical activity in the brain. The electrodes will continuously monitor brain activity, and if a seizure is detected, they can send an electrical signal to try to stop a seizure in its tracks.

In one study reported in 2020, responsive neurostimulation reduced seizure activity by about 60% compared to alternative approaches like vagus nerve stimulation.

Laser Interstitial Thermal Therapy

Laser interstitial thermal therapy (LITT)  is a relatively new treatment for drug-resistant seizures. During the procedure, the neurologist will navigate to the brain region responsible for the seizure activity. The surgeon will drill a small hole and insert a wire connected to a laser that can heat the specific region of the brain and destroy the tissue responsible for the seizure activity.

Laser-based treatments for seizures often require highly specialized healthcare teams, and only specific centers can perform these operations at this time.

Surgical Resection

Surgical resection is a form of surgery in which portions of the brain that are prone to seizures are removed. Surgical resection is one of the oldest and most long-standing forms of surgery for epilepsy.

Lobectomy

In a lobectomy, a surgeon will identify portions of the brain that are prone to seizure activity and remove them. Often, the procedure focuses on the temporal lobe of the brain since this area accounts for over 70% of epilepsy cases.

Hemispherectomy

In a hemispherectomy, a radical surgical approach is used, which removes up to half of the brain. With the advent of more recent surgical innovations, hemispherectomy is used less commonly and often only in cases where other treatments have failed.

Multilobar Resection

In multilobar resection, multiple portions of the brain are removed across different lobes in an attempt to control seizure activity. This form of surgery is similar to hemispherectomy but is more radical and less frequently used. However, it is available for difficult-to-control seizures.

Surgical Disconnection

The brain is wired together with a series of pathways that carry electrical signals. Surgeries have been developed that disconnect these electrical highways to help control seizures.

Corpus Callosotomy

A corpus callosotomy is a procedure used to treat atonic (drop) seizures. The procedure involves cutting the connection between the two halves of the brain, the region known as the corpus callosum.

The disruption will affect how the brain controls muscles on one side of the body. It can allow the other half to maintain strength if a seizure occurs and help prevent a fall.

Multiple Subpial Transections

The subpial transection is another surgical approach that involves severing neuronal connections in the brain. In this procedure, the surgeon will localize regions of the brain with seizure activity and attempt to cut the connections in the brain.

The surgeon does not remove any brain matter and instead leaves the tissue in place. The goal is to reduce the potential for abnormal electrical connections to form within the brain that may lead to a seizure.

Risks and Results

While surgery for epilepsy can create a lasting impact, keep in mind that surgery has inherent risks. Surgery in the brain can result in loss of memory, function, and sensation. While infrequent, complications like infections, bleeding, and loss of function can also occur after brain surgery. Your healthcare team will work to reduce any potential risks prior to any surgical procedure.

Results from epilepsy surgeries are generally very good and people can see success after the procedures. The specific results will vary among the different types of epilepsy that are treated and the various procedures.

For example, among people with a responsive neurostimulator, as many as 76% reported a reduction in their seizure activity in one 2018 study. For laser interstitial thermal therapy around 66% of people undergoing the procedure have freedom from seizure activity.

The results of any procedure will vary from person to person and your healthcare team will work to outline the most appropriate procedure for you.

Summary

In the past, drug-resistant seizures were difficult to control and there were limited treatments. Now, there are many surgical options for epilepsy and drug-resistant seizures. Surgery can provide symptom relief and reduce the number of seizures over time for some people living with epilepsy.

If you think you might be a candidate for surgery, work with your healthcare provider to evaluate your options.

Frequently Asked Questions

Can surgery cure epilepsy?

For the majority of people, surgery will reduce symptoms and seizure activity, but it may not entirely cure epilepsy. There is always the potential for surgery to cure epilepsy, but it is not guaranteed. 

How long does it take to recover from epilepsy surgery?

How long recovery takes from epilepsy surgery varies from person to person and depends on the type of procedure performed. In some procedures like vagus nerve stimulation, you may be able to return home shortly after your procedure. In other cases, you may be closely monitored for several days after your procedure.  

Which type of epilepsy surgery is the least risky?

All surgeries for epilepsy carry risk. Fortunately, with the development of more minimally invasive techniques and smaller incisions, surgery for epilepsy has become much safer. Work with your healthcare team to evaluate your options for surgery, including which option is the least risky for you.