What surgery can change, and what it risks.
The point of epilepsy surgery is not just fewer seizures. It is the life that fewer seizures make possible. The benefits below are what our patients most often tell us about. The risks are real and are part of every conversation we have before surgery.
Seizure control.
For many patients, surgery substantially reduces the frequency and severity of seizures, and for some it stops them altogether. How likely that is depends on the type of epilepsy and the operation, and your surgeon will give you the numbers that apply to your situation. Better seizure control tends to bring more independence and the freedom to do things that the risk of a seizure had ruled out.
Less medication.
After successful surgery, many patients are able to reduce the number or dose of their antiseizure medications, which means fewer side effects from long term use. Any change in medication happens slowly and under the direction of your epilepsy provider.
Thinking and mood.
Frequent seizures interfere with memory, attention, and learning. When seizures are controlled, these often improve. Patients also commonly report better mood, self confidence, and social life, with less anxiety and depression than before.
Safety.
Seizures cause falls and injuries, and uncontrolled seizures raise the risk of sudden unexpected death in epilepsy (SUDEP). Reducing seizures lowers both risks.
Surgery and survival.
Surgery lowers the risk of death from epilepsy by about two thirds. In the studies summarized by the International League Against Epilepsy, there were 8.6 deaths per 1,000 person-years among 1,006 patients who had surgery, and 25.3 deaths per 1,000 person-years among 104 patients who did not. A second study of 590 surgical and 122 nonsurgical patients confirmed lower overall mortality and lower SUDEP mortality after surgery. Patients who become seizure free have the same life expectancy as the general population.
Data from the mortality series summarized in Jehi L, et al., Epilepsia 2022, citing Bjellvi 2019 and Lewis 2021.
Waiting has a cost. Patients who became seizure free had epilepsy for 2.8 fewer years at the time of surgery than those who did not. In children, delay can forfeit developmental windows that early surgery can protect.
Long term health.
Repeated seizures can injure brain cells over time. Controlling them helps preserve cognitive function and protects the brain from further damage. Overall health often improves when the body is no longer subjected to the repeated stress of seizures.
Practical benefits.
Surgery is expensive up front, but it can reduce long term costs by cutting emergency visits, hospital stays, and medication expenses. Patients with better seizure control are more often able to return to work or school.
Risks and complications.
The risks of any brain operation include infection, bleeding, and new neurological problems such as difficulty with memory, speech, vision, or movement. There is also a chance that seizures continue after surgery. The specific risks depend on the operation and on where in the brain it is done, and your surgeon will review them with you in detail before you decide. For stereo EEG, the risk of bleeding is about 0.17 percent per electrode and the risk of infection about 4 percent.
Long term outcomes.
Many patients experience a large reduction in seizures or become seizure free. The expected outcome for your specific surgery will be discussed with you before you decide, so that you can weigh it against the risks and against continuing on medication alone.
What we expect from neuromodulation.
Quality of life and seizure burden are measured outcomes of neuromodulation. We expect every patient to achieve more than 50 percent seizure reduction. In RNS trials, quality of life and mood improved at 1, 2, and 9 years. There are no cognitive side effects, just potential improvement. Programming takes months, and benefit accrues over years.
Living with the device.
Your doctors have access to your brain recordings, which means your treatment is personalized to your own seizures. The recordings can be used to adjust your medications. Caregivers no longer have to track every seizure, because the device does.
Meador KJ, et al. Epilepsy & Behavior 2015. Nair DR, et al. Neurology 2020.