Is Epilepsy Surgery Underused in Adults?

About 3 in every 10 people with epilepsy will find that anti-seizure drugs do not bring relief. Plus, it may take 1 to 2 years of treatments to know whether medicine helps.^1,2

Uncontrolled epilepsy may interfere with your work and social life. It may also lead to serious health conditions, including:²

• Cognitive disorders
• Depression
• Physical trauma
• Sudden death

When drugs do not help your epilepsy, surgery may be an option. Surgery is commonly associated with children with epilepsy. But it can be a good choice for some adults too.²

Surgical options can relieve seizures. However, research shows that epilepsy surgery is underused in adults. This is despite clear guidelines for referring people who do not respond to anti-seizure drugs.^3-9

Evaluations for epilepsy surgery

If anti-seizure drugs do not work, your doctor may refer you for a surgical evaluation. This should take place at a specialized epilepsy center. The evaluation will include advanced imaging techniques, such as:^2,8

• High-resolution magnetic resonance imaging (MRI)
• Electroencephalography (EEG)
• Ictal SPECT

Images made by these tests can help your doctors to evaluate if surgery will help you. They can also help the surgeon to plan the surgical procedure.^2,8

Choosing epilepsy surgery

People who chose to undergo epilepsy surgery want to gain a higher quality of life. Most want to maximize their relief from seizures while experiencing few to no side effects.²

However, surgery can only help people whose epilepsy can be traced to a specific area of their brain. Plus, surgeons must be able to reach that area of the brain with low risks of complications.²

Types of epilepsy that surgery may help include:²

• Temporal lobe epilepsy
• Neocortical epilepsy
• Lesional epilepsy

There are some risks from having epilepsy surgery. About 1 in every 3 to 4 people will have some degree of memory loss. Surgery on the left temporal brain lobe can cause declines in verbal memory. Those who have right-sided surgery may experience problems with spatial memory and learning.^1,2

Trends in underuse of surgery

It takes about 20 years for people with epilepsy who can be helped by surgery to get a referral. But by this time, they may have disabilities that can not be reversed.^4,8

Studies have shown that the earlier surgery is performed in the disease course, the better the outcomes. However, data shows that rates of epilepsy surgery declined between 1990 and 2014.^5,7,8

This is surprising since about 5 in 10 people with epilepsy who have surgery are freed from significant seizures. Those who still experience seizures after surgery usually have them less frequently. This tends to be a long-lasting outcome of surgery.^1,8,10

What explains these trends?

One reason may be that people with epilepsy who are referred for surgery simply decline to have it. At least one study suggests that declining rates of surgery could be because the risks are now better explained by doctors.⁹

A second reason is that some epilepsy surgery evaluations may be happening at community hospitals instead of specialized epilepsy centers. While rates of surgery at epilepsy centers are declining, admissions at community hospitals for epilepsy have increased. Epilepsy surgeries performed outside of specialized centers tend to lack neurology specialists. They also have twice the rate of post-surgery complications compared to epilepsy centers.⁶

Last, a lack of referrals for epilepsy surgery may be a sign of complex the condition can be to treat.⁸

If you have epilepsy and anti-seizure drugs are not working to reduce your symptoms, ask your doctor if surgery can help you.