The Johns Hopkins Epilepsy Center

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Surgery for epilepsy is an individual decision, motivated by different reasons in different individuals. Surgery is considered when seizures are frequent enough and/or severe enough to significantly interfere with a person's ability to function at full capacity. Surgery also is considered when trials of appropriate anti-seizure medications have failed.

Patients with progressive neurological disease or other significant medical problems such as cancer or heart disease usually are not considered for epilepsy surgery. Patients of any age, including infants, may be considered for surgery if other criteria are met.

A team of neurologists, neurosurgeons, nurse specialists and neuropsychologists participate in the evaluation of each patient being considered for epilepsy surgery.

The evaluation process includes taking a patient and family history and several studies are conducted including a baseline EEG, CT Scan and/or MRI, and intensive scalp seizure monitoring with simultaneous Video/EEG recording and monitoring. A neuropsychological evaluation also is performed.

Some patients require intensive Video/EEG monitoring using electrodes placed surgically within or around the brain itself before the final seizure surgery can be performed. The need for electrodes is considered on an individual basis. Other tests also considered on an individual basis are the Wada test, PET scans, SPECT scans, and psychiatric evaluations.

The EEG (electroencephalogram) involves recording a patient's brain waves. The goal is to record and analyze the seizure discharges which occur in the brain waves. CT (computerized transaxial tomographic) and MRI (magnetic resonance imaging) scans can help to indicate where a patient's seizures originate. Magnetic resonance-based techniques are in use or under development that will help assess not only brain structure, but also brain function. PET (positron emission tomographic) and SPECT single photon emission computed tomographic) scans test brain metabolism, chemistry or blood flow with the use of specially prepared radioisotopes which have been found safe for medical diagnostic use.

Surgery for epilepsy is a complicated process which involves different surgical options. The neurologist and neurosurgeon will discuss which options are appropriate for each patient during the pre-surgical evaluation.

The basic types of epilepsy surgery are: