Epilepsy surgery

The aim of epilepsy surgery is to improve quality of life by stopping seizures or significantly reducing their frequency and/or severity.

Criteria for epilepsy surgery

You can be considered for epilepsy surgery if:

• you have tried two or more anti-epileptic drugs and they have not stopped or significantly reduced your seizures
• you are experiencing focal seizures (seizures that begin in a specific area of the brain).

If you meet these criteria, and would like to find out if you are eligible for epilepsy surgery, speak to your GP or local Neurologist.

About seizures - Epilepsy Action

We also provide alternatives for people who may not be suitable for surgery:

Alternatives to surgery

Types of surgery

In Oxford we offer resective surgery. This is where the brain tissue that is causing seizure activity is 'resected' or removed to prevent the production of further seizures.

There are three main types of resective surgery.

Temporal lobe surgery

This is the most common type of surgery for people with temporal lobe epilepsy, and can involve a 'lobectomy' or an 'amygdalohippocampectomy'. This is where the brain tissue in the temporal lobes that is causing the seizures is removed.

Extratemporal surgery

In this type of surgery, the brain tissue that is causing seizures in other parts of the brain, for example the occipital, parietal or frontal lobe, is removed.

Lesionectomy

This surgery involves removing tumours, abscesses or other damage in the brain that has been causing seizures.

If you are not suitable for resective surgery, then Vagus Nerve Stimulation may be an option for you.

Benefits and risks

Specific benefits and risks of surgery will be different for each person. The risks of surgery need to be considered along with the risks of continuing to experience seizures. Our extensive assessment process will provide us with information that is relevant to you. Ultimately, the decision to undergo surgery is yours.

Even if you become seizure free, you will be expected to stay on medication for at least one to five years after surgery. In the longer term however, it may be possible for some people to stop medication. This may be of particular benefit for people experiencing significant side-effects from medication.

If successful, surgery can lead to increased independence, confidence and self-esteem, and reduce the burden and psychological impact of frequent seizures. This may allow people to regain their driving licence, return to work and re-engage with social activities.

Potential benefits of surgery

• Seizure freedom
• A reduction in seizure frequency or severity
• A reduction in the risks associated with frequent or severe seizures, including injury and Sudden Unexpected Death in Epilepsy (SUDEP)
• Improvements in quality of life
• Potential reduction in medication in the long term

Potential risks of surgery

• Risks associated with the surgical procedure itself, including haemorrhage and infection
• Cognitive difficulties
• Visual field problems
• Mood difficulties
• No change in seizure control

Although the level of risk will differ between people, memory, language, visual field impairment and mood-related difficulties are more common with temporal lobe surgery.

The risks and benefits specific to you will be evaluated extensively in the assessment process.

Alternatives to surgery

If it is decided by the multidisciplinary team that surgery is not suitable for you, we appreciate this can be disappointing.

However, the extensive assessment process can provide valuable additional information about your epilepsy which will be used to inform your care. Your Neurologist will discuss the reasons for this decision and what further support can be offered.

Vagus Nerve Stimulation

We provide Vagus Nerve Stimulation for people who may not be suitable for surgery.

This is a treatment for epilepsy that involves implanting a small stimulator into the upper area of the chest. The stimulator is attached to the left vagus nerve and sends a regular small electrical 'pulse' to the nerve to help calm electrical discharges that lead to epileptic seizures.

Medication review and adjustment

It may be possible to treat you by carefully monitoring your medication and changing it to suit your circumstances better.