In simple terms epilepsy surgery refers to surgery which is carried out to remove the area of the brain which is generating the seizures. Epilepsy surgery though needs careful planning and an extensive diagnostic work-up and hence is usually available only in level IV epilepsy centers. The epileptogenic focus (area of the brain generating the seizure) has to be identified and this is accomplished with the aid of video (continuous) EEG monitoring, at times intracranial EEG monitoring, MRI scans, PET and SPECT scans. Neuropsychological testing and a special test called WADA test is also done which helps to identify the location of language and memory centers in the brain.
After the above testing (some patients may need less, others additional testing), we determine whether a patient is a good surgical candidate, what kind of surgery to offer him and what are the chances that he shall be seizure free after epilepsy surgery.
Nitin K Sethi, MD