Department of Neurology

Surgery for non-intractable epilepsy

Q: Due to advanced diagnostics and safer surgical procedures, a number of epilesy centers around the country are boasting impressive success rates, upwards of 85%. Yet the surgeries are only being done on those with "intractable" disorders. Are we getting close to the time when surgeries are going to be more commonplace for those of us who are "controlled" on current drug therapies but must still suffer through side-effects, lifestyle impairments and occasional breakthrough seizures? Thanks in advance.

A: The main goal of epilepsy surgery is to make seizures controllable with medication. Thus, the success rate you quote includes a large number of persons who still have to take medicine. In fact, only about 10-20 per cent of persons get off of all medications after epilepsy surgery. Thus, surgery does not necessarily eliminate the need for medications.

There is also a finite loss of brain that occurs with epilepsy surgery, and many persons have measurable changes on testing. This is usually off set by the gains made from seizure control, but a potential loss would be of concern for someone who could be controlled with medications alone.

The future of epilepsy is probably not to perform surgery on persons who can be controlled by medications, but rather to keep developing new drugs and therapies with less side effects.

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