Epilepsy surgery

• When to consider it? This is a very personal question. Probably the best answer is when you feel your quality of life is impaired. For some people that means one seizure per year, enough to prevent them from driving and working. For some others, having many seizures per day is more acceptable than undergoing brain surgery. In general, the recommendation is that surgery is something to consider after a person fails to respond to three major anticonvulsants. Then the possibility of being controlled with the fourth one is less than 5%.

• What surgery is right for me? 

• What to expect before surgery/how to prepare for surgery? It is important to understand that the pre-surgical evaluation could take a few months to complete. This is because it is essential that your doctors make sure that all the seizures arise from a single part of the brain and that there is no function there to avoid potential damage.

• What to expect during hospitalization for surgery?
  - How long would I have to stay in the hospital? The time spent in the hospital will depend on the type of evaluation needed to accomplish the goals (localize the seizures and make sure that it is safe to remove that part of the brain). 
  - Would I need an evaluation with electrodes in or on the brain? If there is a need for an invasive evaluation (electrodes in or on the brain), then the patient will have a first surgery to implant the electrodes, will then go to the intensive care units for a few days and then will be transferred to the epilepsy unit.  Seizures will be recorded on the unit and brain mapping can be completed. Afterwards, the patient will go back to the operating room for the electrodes to be removed, and, if indicated, surgery  can be performed.
  - How long do I stay if I only need surgery (with no evaluation with electrodes in or on the brain)? If an invasive evaluation is not needed and there is a straightforward resection of the part of the brain causing the seizures (seizure focus), then the duration of the stay is approximately a week. 
  - What are possible side effects and complications from surgery? 
  - Does the surgeon have special training and expertise in epilepsy surgery?
  - How many surgeries has she/he done?

• What to expect after surgery?
  - Rest at home for a month with minimal activities
  - Return to normal activities and work in 3 months
  - Return to see the brain surgeon for follow up