Counselling for surgery
If surgery is appropriate, you will meet the neurosurgeon to discuss aims, risks, expectations and how your life can change if you become seizure-free.
Information will be delivered in a personalised way, to make it as clear and understandable as possible.
If you don’t feel ready to opt for surgery, you don’t need to decide straight away. You will receive a paper letter with the same information discussed and you can contact us when you have decided.
When you decide to go ahead, we will offer a date suitable for you.
What are the surgical options for epilepsy?
Once the seizure generator (Epileptogenic Zone, EZ) is found, "Resective surgery" is offered if there is agreement that it can be safely taken away.
The operations differ according to where the EZ is located in the brain, but the most common are:
- Anterior temporal lobectomy (and variants): the temporal lobe (the bit of brain sitting between the ear and the eye) is one of the most common source of epilepsy. Part of this brain tissue is removed with this operation.
- Lesionectomy: an abnormality or damage in the brain (e.g. malformations / tumours) is cut away. The area to be taken away is decided on the basis of the previous investigations. Cutting edge technologies are used to make sure the whole area of interest is removed, even in case where the MRI appears normal.
- Brain surgery in critical brain areas (so called “eloquent brain”): in these cases surgery may still be possible using special techniques, such as awake surgery or intraoperative monitoring.
- Disconnections: sometimes it is preferable to disconnect the seizures’ generator from the rest of the brain, rather than removing it. These operations can take many names according to the type of disconnection.
Benefits of surgery
Our team aims to select patients who have relevant chances to have their epilepsy cured, mitigated or controlled.
Recognised, universal benefits from seizure control are:
- increased independence, confidence and self-esteem
- regaining driving licence in some cases
- returning to work
- re-engaging with social activities
- reduction / termination of medications
Risks of surgery
Each surgery will be different from case to case, hence the benefits and risks will be discussed individually. Most of the possible problems are transient and can be managed in the hospital.
What if brain surgery cannot be offered?
Some brain circuits can be modified by specific devices to help normalise the electric activity that causes the seizures. Its aim is to reduce the frequency and intensity of seizures rather than curing from epilepsy.
- Vagus nerve stimulator (VNS): it can be considered like a pacemaker for the brain. It is implanted nearby the left collar bone and connected with a lead to a nerve of the neck (vagus nerve). The operation carries small risks, the most common is a possible change in your voice quality and power. Certain types of epilepsy have better chances to benefit from this device - half of the patients selected for this operation will enjoy a 50% reduction of seizure frequency / intensity.
- Deep brain stimulation (DBS): very rarely used in our department as it's less appealing than VNS (almost equal chances of improvement, but higher risk of adverse effect). Research on this field is ongoing and future breakthroughs may make it a more attractive option.
Support through and after your journey
- Local Employment Service for training and job finding
- National Union of Students for grants and education
- Citizen Advice for benefits, housing, and employment
It may be helpful to talk to people who have had surgery previously, in larger meet-up forums or smaller social meetings. If you'd like to do this, you can let us know or contact various national support organisations. Of course everyone’s experience is personal and your management plan may be different - you can search for people with same type of epilepsy and who underwent the same type of operation, so that what you hear is relevant to you.
Frequently Asked Questions
You can view further information and advice on our Epilepsy Surgery Programme FAQs page.