Epilepsy surgery may be considered when seizures continue despite appropriately chosen and tolerated anti-seizure medicines. This is known as drug-resistant epilepsy. Ongoing seizures can cause injury, affect education or employment, limit independence and increase health risks, so referral for a comprehensive epilepsy evaluation should not be unnecessarily delayed.

At Apollo Adlux Hospital, Angamaly, evaluation for epilepsy surgery is designed to answer three questions: where seizures begin, whether that area can be treated safely, and which operation or neuromodulation approach offers the most appropriate balance of seizure control and functional protection.

Who may benefit from evaluation

Referral may be appropriate for adults or children with focal seizures that persist despite suitable medicines, seizures caused by a visible brain lesion, disabling medication side effects, or uncertainty about the diagnosis. Evaluation does not commit a patient to surgery; it clarifies the seizure type and options.

Urgent medical attention is needed for a seizure lasting five minutes or longer, repeated seizures without full recovery, serious injury, breathing difficulty, a first seizure, or a seizure during pregnancy.

Presurgical evaluation

Assessment may include a detailed epilepsy history, MRI using an epilepsy protocol, EEG and prolonged video-EEG monitoring. Depending on the case, functional imaging, neuropsychological testing, speech and memory assessment, or invasive electrode monitoring may be required. The findings are reviewed by a multidisciplinary epilepsy team.

The aim is to identify the epileptogenic zone and map nearby language, memory, movement and sensory function. If the seizure focus cannot be localised safely, a different treatment strategy may be recommended.

Types of epilepsy surgery

Procedures may include removal of a seizure-causing lesion, resection of a focal seizure area, temporal lobe surgery, or disconnection procedures in selected severe epilepsy syndromes. Awake mapping may be used when the focus lies near critical language or movement areas.

When resection is not appropriate, selected patients may be evaluated for neuromodulation, such as vagus nerve stimulation or deep brain stimulation, subject to clinical indication, device availability and regulatory approval. The expected outcome varies: some procedures aim for seizure freedom, while others aim to reduce seizure frequency or severity.

After surgery

Anti-seizure medicines usually continue after surgery and should never be stopped without specialist advice. Follow-up includes seizure tracking, medication review, wound care and assessment of memory, mood, school or work needs. Driving and safety restrictions continue according to medical advice and applicable law.