Are You or Your Family Member a Candidate for Epilepsy Surgery? Questions to Ask Before the Referral

Medicine Made Simple Summary

For people living with epilepsy that does not improve despite proper medication, surgery can become a possible next step. However, not everyone with epilepsy is a suitable candidate. Determining eligibility requires careful evaluation by neurologists and surgeons who specialize in epilepsy. This article explains how doctors decide if surgery might help, what questions families should ask before referral, and what the evaluation process involves. By understanding these steps, patients and caregivers can make informed decisions about whether to explore epilepsy surgery further.

Understanding When Epilepsy Becomes Drug-Resistant

Epilepsy is a neurological condition where abnormal electrical activity in the brain causes seizures. For most people, seizures can be managed with medication. But around one in three individuals continue to have seizures despite trying two or more appropriate anti-seizure medicines. This is known as drug-resistant epilepsy. The diagnosis is not made after just one or two failed drugs, but only after careful trials under specialist supervision. When epilepsy is drug-resistant, the chances of achieving long-term seizure control with further medication drop sharply. At this point, doctors begin considering other treatments, including surgery, dietary therapy, or neuromodulation. Recognizing drug resistance early allows families to seek surgical evaluation before long-term complications like memory decline or social limitations develop.

What Makes Someone a Candidate for Epilepsy Surgery?

Epilepsy surgery is not appropriate for every person with epilepsy. The best candidates are individuals whose seizures consistently arise from a single, identifiable area of the brain — called the seizure focus.

If removing or disconnecting that focus can be done safely without causing loss of important functions like speech, movement, or vision, surgery may offer significant benefit.

Other key factors include the patient’s general health, age, and willingness to undergo detailed testing. People with generalized epilepsy, where seizures start in multiple brain areas, are less likely to benefit from surgery and may be better suited for other treatments such as neurostimulation.

Why Early Referral Matters

Early referral to an epilepsy surgery center can make a big difference. Many families wait years, hoping that another medication will finally work. However, studies show that once two well-chosen anti-seizure drugs have failed, the chance of the next one controlling seizures is below 5%.

Delaying surgery can lead to cumulative brain injury from ongoing seizures, impaired learning, and reduced quality of life. Children with uncontrolled seizures may fall behind in development, while adults may struggle with employment and independence. Evaluating surgical options early does not mean committing to surgery immediately—it simply ensures all potential treatments are explored while they are most effective.

The Pre-Surgical Evaluation Process

Before recommending epilepsy surgery, specialists conduct a thorough evaluation. The process can take several weeks and involves a multidisciplinary team, including neurologists, neurosurgeons, neuropsychologists, and radiologists. The goal is to confirm that the seizures start from one clear brain region and to assess whether surgery can be performed safely.

The main components of pre-surgical evaluation include long-term video EEG monitoring, which records brain activity during seizures to pinpoint where they begin; high-resolution MRI to look for structural abnormalities; and neuropsychological testing to assess memory, language, and problem-solving. Sometimes, doctors use additional imaging such as PET or SPECT scans, which show how different brain areas use energy.

In selected cases, intracranial EEG is performed by placing electrodes directly on or in the brain to map seizure onset more precisely. These tests provide a complete picture of seizure patterns and brain function to guide the surgical decision.

Questions to Ask Before a Referral

Families considering surgery often feel uncertain about when to ask for a referral. Asking the right questions helps clarify readiness and expectations. Key questions include:

• Have at least two appropriate anti-seizure medications failed to control seizures?
• Do seizures start from one specific part of the brain, or are they generalized?
• How do seizures affect daily activities, safety, and quality of life?
• What risks are associated with delaying surgical evaluation?
• Does the current hospital have experience with epilepsy surgery, or should we go to a specialized center?

Discussing these questions openly with your neurologist ensures timely referral and avoids unnecessary delays.

Common Myths About Epilepsy Surgery Eligibility

Several myths often prevent patients from being referred for surgery. One common misconception is that surgery is a ‘last resort’ or an extreme measure. In reality, epilepsy surgery is a scientifically proven and safe treatment for many people when medications fail. Another misconception is that children are too young for surgery, but evidence shows that early surgical intervention in children with localized epilepsy can improve development and quality of life. Some families worry about the risk of brain damage, but modern surgical techniques use precise imaging and mapping to protect critical areas. Understanding these facts encourages timely evaluation rather than waiting until seizures become disabling.

What to Expect During the Evaluation Journey

Being evaluated for surgery does not automatically mean you will undergo an operation. In many cases, testing confirms that surgery is not suitable, and other options like neurostimulation or dietary therapy are explored.

However, the evaluation itself provides valuable information about seizure type, medication effectiveness, and long-term management. During hospital-based video EEG monitoring, patients stay for several days while seizures are recorded under controlled conditions. This can feel intimidating, but it is safe and carefully supervised.

After all tests are completed, the multidisciplinary team reviews results in a case conference and discusses findings with the family. If surgery is recommended, the team explains the type of procedure, benefits, and possible risks in detail.

How Doctors Decide If Surgery Is Safe and Useful

After testing, the surgical team assesses two key questions: Can surgery stop or reduce seizures, and can it be done safely? If the seizure focus lies in a region that controls language, movement, or memory, surgeons evaluate whether that area can be avoided. In some cases, functional mapping is done while the patient is awake under local anesthesia to ensure that vital functions remain intact.

If the seizure focus is located in a deep or critical area where resection is risky, alternative approaches such as laser ablation or neuromodulation may be suggested. Ultimately, the goal is to balance maximum seizure control with preservation of normal brain function.

When Surgery May Not Be Recommended

Surgery is not suitable for every case of epilepsy. People whose seizures start from multiple areas of the brain or spread too quickly may not benefit from focal surgery. Those with progressive neurological disorders, widespread brain injury, or severe medical conditions that increase surgical risk are also less likely to be candidates.

For such patients, treatments like vagus nerve stimulation, responsive neurostimulation, or medication adjustments are considered instead. Even when surgery is not possible, going through the evaluation helps identify the most effective management plan and improves overall seizure care.

The Importance of Choosing the Right Centre

Epilepsy surgery should be performed in specialized centers with experienced teams and access to advanced diagnostic tools. These centers provide comprehensive evaluation, multidisciplinary discussion, and post-surgical rehabilitation. Outcomes tend to be better when surgery is done by experienced specialists in high-volume hospitals.

Families should ask about the center’s success rates, the types of surgeries performed, and the availability of support services. A well-equipped center not only ensures surgical precision but also provides counseling and follow-up care to support recovery.

Conclusion

If seizures continue despite multiple medications, discuss a referral to an epilepsy surgery center with your neurologist. Early evaluation helps determine whether surgery could be beneficial and prevents years of unnecessary trial and error. Being informed and proactive allows families to take the next step toward better seizure control and improved quality of life.