Can neurosurgeons treat epilepsy?

Epilepsy is primarily managed by neurologists with anti-seizure medication. Most patients gain excellent control with the right combination of drugs.

About a third of patients continue to have seizures despite adequate medical treatment. For these patients — particularly if seizures come from a single identifiable area of the brain — surgery may be an option.

The most common epilepsy operation is temporal lobectomy for mesial temporal sclerosis, which has very high rates of seizure freedom. Other options include lesionectomy (removing a specific lesion causing seizures), disconnection procedures, and neuromodulation devices such as vagus nerve stimulators.

Deciding on epilepsy surgery is a big undertaking. It requires detailed investigation — long-term video EEG monitoring, high-resolution MRI, neuropsychological testing, and often invasive electrode recordings — usually in a dedicated epilepsy surgery centre.

If your seizures are not controlled despite trying two or more medications properly, ask your neurologist about a referral to an epilepsy surgery programme. Surgical options are considered too late in many patients.