Epileptologist Prachi Parikh, MD speaks with a patient in clinic.
Epilepsy surgery can be highly effective at reducing or eliminating seizures. However, many people don’t understand the potential benefits and when epilepsy surgery should be considered, said Derek Southwell, MD, a Duke Health neurosurgeon who specializes in epilepsy surgery.
Here, Dr. Southwell and Prachi Parikh, MD, a Duke Health epileptologist (a neurologist who specializes in epilepsy care), answer five common questions about epilepsy surgery. “Answering these questions can help you understand whether surgery may fit into your care plan,” Dr. Southwell said.
1. Should I consider epilepsy surgery?
If you’ve tried at least two anti-seizure medications and you’re still experiencing breakthrough seizures that affect your quality of life, ask your doctor for a referral to a comprehensive epilepsy center like Duke. Although the idea of brain surgery can be frightening, speaking with an epileptologist can help you understand the potential benefits and risks of epilepsy surgery.
“Think of it as information-gathering for you and your doctor to find out if surgery is an option for you,” Dr. Parikh said. If so, you can decide whether you want to begin the evaluation process, which may include inpatient EEG studies and surgical procedures to pinpoint where your seizures begin. “If surgery is not the best option, we can pursue other paths to better control your seizures.”
2. What are my epilepsy surgery options?
There is a wide range of epilepsy surgical procedures, including removing brain tissue that causes seizures. There are minimally invasive options like laser interstitial thermal therapy (LITT), implantable neurostimulation devices like deep brain stimulators (DBS), and responsive neurostimulators (RNS).
According to Dr. Southwell, regardless of which operation you have, you should be able to eat, walk, and get dressed independently within 24 hours after surgery. Typically, you only have to stay in the hospital for one to three nights. People usually go back to work after three to six weeks, depending on the procedure type.
3. What are the potential complications of epilepsy surgery?
With any surgery, there are risks like bleeding and infection. Rarely, epilepsy surgery can affect brain functions like language, vision, or memory. “When we evaluate someone for epilepsy surgery, we do tests that help us understand the potential impacts on brain function,” Dr. Southwell said. The risks are unique for every person, and your doctor will discuss them with you in detail before you decide to have epilepsy surgery.
4. Does epilepsy surgery eliminate the need for anti-seizure medications?
In some cases it does, but not usually. Your doctors may reduce the number and doses of seizure medications you take, which can mean fewer side effects.
5. Where should I go to discuss epilepsy surgery?
According to Drs. Parikh and Southwell, you should seek treatment from an epilepsy center recognized by the National Association of Epilepsy Centers for providing highly specialized care. As a Level 4 Epilepsy Center, Duke Health provides the most advanced surgical treatments to people with epilepsy. It is one of the reasons why Duke University Hospital’s neurology and neurosurgery program is nationally ranked, and is the highest ranked program in North Carolina, according to U.S. News & World Report in 2020-2021.