Epilepsy Surgery

Published: August 2026  ·  For patients with drug-resistant epilepsy and their families

If you or a family member continues to have seizures despite trying two or more anti-seizure medications, you have drug-resistant epilepsy — and surgery may offer the best chance of seizure freedom. Nearly one in three people with epilepsy does not achieve full control with medication alone.^[1] This page explains the surgical options, the evaluation process and what to expect.

When is epilepsy surgery considered?

Surgery is considered when:

• Seizures originate from a localized region of the brain (a "focus").
• That region can be removed or modulated without causing unacceptable deficits.
• Seizures continue despite adequate trials of at least two appropriate medications.
• The impact of seizures on quality of life outweighs the surgical risk.

The earlier surgery is considered in the course of the disease, the better the potential outcome. Delaying evaluation for many years is associated with worse psychosocial outcomes even when surgery ultimately succeeds.^[2]

The pre-surgical evaluation

This is the most important step. Our multidisciplinary epilepsy team — neurosurgeons, epileptologists, neuropsychologists and neuroradiologists — works to localize the seizure focus with:

1. Video-EEG monitoring — continuous recording of brain waves and video over several days to capture typical seizures.
2. High-resolution MRI — to identify a structural lesion such as hippocampal sclerosis or a cortical malformation.
3. Neuropsychological testing — to map memory and language baseline and predict surgical risk.
4. Functional imaging — PET, SPECT and fMRI help confirm the focus and protect eloquent brain regions.
5. Intracranial electrodes — if non-invasive tests are inconclusive, electrodes are placed to record directly from the brain surface or within the brain.

Surgical options

1. Resective surgery

Removing the seizure focus is the most effective surgical option for suitable candidates. Procedures include temporal lobectomy, lesionectomy and focal cortical resection. Among appropriately selected patients, temporal lobe epilepsy surgery achieves long-term seizure freedom in roughly 60–70% of cases.^[3]

2. Laser interstitial thermal therapy (LITT)

A minimally invasive option where a thin laser probe heats and destroys a small seizure focus, guided by real-time MRI. LITT offers shorter recovery than open resection for well-selected lesions such as mesial temporal sclerosis.^[4]

3. Responsive neurostimulation (RNS)

An implanted device continuously monitors brain activity and delivers targeted stimulation the moment a seizure pattern begins — without removing brain tissue. Ideal when the focus involves eloquent cortex.

4. Vagus nerve stimulation (VNS) and corpus callosotomy

VNS modulates brain activity via a device implanted in the chest. Corpus callosotomy — division of the connection between hemispheres — is reserved for severe generalized seizure types such as drop attacks.

Outcomes and what they really mean

Seizure freedom is the goal, but the outcome spectrum is honest and individual. Some patients become completely seizure-free; many others achieve a meaningful reduction in seizure frequency and severity. Improved seizure control is consistently associated with better quality of life, mood, and the ability to return to work or driving (subject to local regulations and seizure-free intervals).^[5]

Risks and side effects

Risks depend on the surgical approach and the region of brain involved. They include infection, bleeding, and neurological deficits such as memory or visual field changes. Your surgeon will explain the specific risks for your plan — including the small chance of complications — and how they are minimized with mapping, neurophysiology and careful postoperative care.

Recovery after epilepsy surgery

• Hospital stay is typically 2 to 5 days for resective surgery, and 1 to 2 days for LITT.
• Most patients return to non-strenuous work within 4 to 6 weeks.
• Medications continue after surgery and are adjusted over months based on seizure control.
• Follow-up includes regular EEG and clinical review, often continuing for several years.

Why patients choose our epilepsy surgery program

• Sub-specialty fellowship training in epilepsy and functional neurosurgery.
• Full in-house evaluation — video-EEG, neuropsychology and imaging under one team.
• Minimally invasive options (LITT) for suitable candidates.
• Virtual screening: send prior EEG and MRI reports for an initial specialist review.
• International patient support for travel, accommodation and long-term follow-up.

Related resources

• Patient FAQ — including seizures causes without epilepsy
• Post-operative recovery guide
• Dr. Sarah Chen — full profile
• Brain tumor treatment

References

1. National Institute of Neurological Disorders and Stroke. Epilepsy and Seizures. Available at ninds.nih.gov.
2. Engel J, et al. Early surgical therapy for drug-resistant temporal lobe epilepsy. Lancet. Available via PubMed.
3. Wiebe S, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. Available via PubMed.
4. American Association of Neurological Surgeons. Epilepsy — Patient Information. Available at aans.org.
5. McClelland S, et al. Long-term outcomes of epilepsy surgery. Journal of Neurosurgery. Available via PubMed.

Request an Epilepsy Surgery Evaluation Call +1 (800) 555-0149