Epilepsy surgery or what is commonly called brain surgery, is one of the available modalities for treating epilepsy, where the area of the brain that causes seizures is removed. This is reserved for epilepsy that is poorly controlled by medication also called as drug refractory epilepsy. The first choice for the treatment of epilepsy always remains medication. In any patient with epilepsy, the underlying cause drives how long the affected individual would require one or multiple medications and its duration. When the affected individual is on good doses of more than two medications, we need to always at least consider epilepsy surgery as the need for more than two medicines implies that quality of life would be impacted. By this definition many epilepsy patients would qualify. While the thought of surgery always strikes a bit of fear, for us specialists, who are very aware of what havoc uncontrolled epilepsy wreaks on the lives of patients and families, not only in its unpredictability, but also on the change in quality of life and social participation, when a patient is eligible for surgery, this is often good news as there is a possibility of a cure and seizure freedom. This is truer in the case of children and young people as they have a longer life ahead and thus can hopefully have a more productive life and years ahead. 

Why do we consider Epilepsy surgery in medication refractory or drug refractory epilepsy? Being drug refractory implies that multiple and long-term seizure medicines must be taken, and these could adversely affect the life of the child and his/her family. This is without considering what toll long term seizure medication has on the body as well as on learning and cognition.  

Broadly speaking epilepsy surgery could be classified into palliative or curative surgery. Curative surgery aims at a cure and palliative surgery aims at improving quality of life, but it is still considered especially when there are severe difficulties, such as seizures as frequent as 50 or more a day! Some of the palliative measures also include techniques such as placing implants like a Vagal nerve stimulator (VNS).   

Discussing the various techniques and types of epilepsy surgery would not be as important as trying to understand the whys and wherefores of epilepsy surgery. While talking about curative and resective surgery, the onus is on the epilepsy surgical team to prove that the seizures originate from one region of the brain and that removing that part of the brain would not cause an unacceptable deficit, such as weakness in a body part etc. Since most children who are appropriately vetted and chosen as epilepsy surgery candidates do well, with a significant proportion even becoming seizure free, and the rest of them showing significant improvement, we in the field of child neurology are always gratified and pleased to see this. This is an advanced technology and specialist intense field as it requires a high level of co-ordination between various specialists, mainly the neurophysician, the neurosurgeon, the MRI specialist as well a close working with specialists reading the electrical activity of the brain. All this workup is mandatory before we proceed to surgery and takes time and effort. This process is called epilepsy surgery evaluation and doing this well is the key to successful outcomes. We need more of such comprehensive centres for epilepsy surgical management as this would improve the lives of many of our children affected with epilepsy.