Summary: Surgery has a definite role in the therapy of some people with epilepsy. Of the three million people with epilepsy, medications are almost always the first line of therapy. One third of those with epilepsy will take medicine but not be controlled. One third of those or about 10% will potentially benefit from surgery. To identify who may benefit, people with epilepsy will need special MRI and other tests. Operations can be done on the very young and even on those more than 70. Each situation needs to be individualized. There are a variety of surgical operations from removal of one small part of brain (the temporal lobe) where the seizure appears to begin to placing different types of devices into or on the surface of the brain in order to find the point where the seizures begin. You need to have the right procedure for the right person. Perhaps unexpectedly, the brain itself does not feel pain; the only parts of the surgery that can potentially cause pain after the surgery are the skin and the outermost very thin covering of the brain – the dura. As a guide, the surgery may take 4-5 hours, pain medicines may be needed for a few days and people are usually home within a few days. Anti-seizure medicines may be continued for up to a year. If we can eliminate the seizures or even markedly reduce them in frequency, we as neurosurgeons and our patients will commonly consider that “a success”.
