Epilepsy surgery

Date Updated: 11/13/2026

By Mayo Clinic Staff

Overview

Epilepsy surgery, sometimes called seizure surgery, most often treats the part of the brain where seizures start. The goal is to better manage seizures and improve the quality of life for people who have epilepsy.

This type of surgery works best if the seizures start in a small, well-defined area of the brain. The procedure may be suggested if the surgery can avoid areas of the brain that handle speech, language, movement, vision or hearing.

Epilepsy surgery is not usually considered a cure for epilepsy. If the surgery results in no seizures, that's usually described as seizure-free and not cured. The outcome of surgery depends on the procedure. Some types of procedures result in seizure-free outcomes for most people. Other people are able to take fewer medicines or lower the dose. Surgery also may cause complications.

An epileptic seizure is the result of irregular activity of a brain cell called a neuron. Surgery to treat seizures depends on the type of seizures you have and the area of the brain where the seizure starts. The type of surgery also can depend on a person's age.

Types of seizure surgeries that involve removing brain tissue include:

Resective surgery. This type of surgery removes all or part of the brain tissue where seizures start. It most often happens when that tissue is in one of the temporal lobes. You may hear this called a lesionectomy or lobectomy.
Laser surgery. This surgery uses heat from a guided laser and is called laser interstitial thermal therapy (LITT). It is done through a small hole in the skull, so it is less invasive than resective surgery. Guided by MRI, the laser can precisely target an area with less chance of injury to other parts of the brain.
Radiofrequency surgery. This surgery uses an electrode placed in the brain. The electrode is placed on the tissue where seizures start. An electrical current passes through the electrode and creates a small area of destroyed tissue.

Other surgeries cut connections within the brain to isolate the activity that leads to seizures. These surgeries, most often suggested to treat epilepsy in children, include:

Multiple subpial transection. This type of surgery involves making several cuts in areas of the brain. Surgeons do this most often when they can't safely remove the area of the brain where seizures start.
Corpus callosotomy. This surgery cuts most or all of the nerves that connect the right and left sides of the brain. It is used to treat seizures that very quickly spread through both sides of the brain. Often this is used to treat children whose seizures lead to abrupt falls.
Functional hemispherotomy. This surgery disconnects the main nerves that allow communication between half of the brain and the rest of the nervous system. A different procedure, called hemispherectomy, removes the half of the brain where seizures start.

Some people have seizure activity in an area of the brain that can't be treated with surgery. For these people, implanted devices to manage seizures may be an option. These therapies include vagus nerve stimulation and deep brain stimulation. Another option is responsive neurostimulation, which is an implanted device that monitors brain waves and disrupts a seizure with electrical stimulation.

Why it's done

Epilepsy surgery is done to manage seizures. Surgery may be an option if you've tried at least two antiseizure medicines that have not been able to manage your seizures. This condition is known as drug-resistant epilepsy. You also may hear it called medically refractory epilepsy. The goal of epilepsy surgery is to stop seizures or limit how bad they are.

Managing drug-resistant epilepsy can lower the risk of some complications from seizures. This includes physical injuries during a seizure, worsening memory or other thinking skills, and sudden unexpected death, which is a rare complication of epilepsy.

A few types of drug-resistant epilepsy may improve after surgery. This includes seizures that are linked to:

The inner part of the temporal lobe, especially the amygdala and hippocampus.
An area that is different from typical brain structure, such as a tumor, or tissue that doesn't form as usual, such as blood vessels or a brain lobe.
An area in the brain identified by imaging and other tests.

Some surgeries may not be an option if the area of the brain is linked to speech, movement, memory or sensations. Surgery also may not be an option if the area responsible for seizures is not in one place, or spans both brain hemispheres. In those situations, implantable devices may be an option. Also, surgery may not be an option depending on other medical conditions you're managing.

Risks

The risks and complications of epilepsy surgery depend on where surgery takes place in the brain. Your surgical team explains the specific risks of your procedure. The team also explains how to lower the risk of complications.

In general, the risks of epilepsy surgery include:

Cognitive changes. Surgery on the left temporal lobe can affect the ability to use and recall words. Right temporal lobe surgery can affect the ability to navigate, find items and learn information. In some cases, these changes are temporary. Children may return to their presurgery level of cognitive function faster than adults.
Visual changes. Temporal lobe surgery can lead to loss of vision in part of the field of vision. This usually affects less than a quarter of the field of vision on the same side in both eyes. These changes may improve for up to two years after surgery.
Mood changes. Some people may report depression or trouble adjusting after surgery.
Muscle weakness or loss of function. If a nerve is damaged during surgery, a condition called cranial nerve palsy is possible. This is the loss of function that depends on which nerve is damaged. Nerves that may be affected can be responsible for eye movement and blinking as well as activity of the muscles in the face. Also, weakness in an arm and leg is a possible complication, called hemiparesis. This can be caused by a blocked artery.

While extremely rare, death can be a complication of epilepsy surgery.

How you prepare

Preparing for epilepsy surgery starts with gathering information on where your seizures are focused in the brain. Your healthcare team also evaluates what brain functions may be affected by surgery. The tests to prepare you for epilepsy surgery are often only available at specialized epilepsy centers.

Electroencephalogram (EEG)

An EEG measures electrical activity in the brain. Small metal discs called electrodes record when brain cells communicate using electrical impulses. The activity can be interpreted to show where irregular activity starts.

To prepare for epilepsy surgery, you may have:

A baseline EEG. Electrodes are placed on the scalp. They can suggest which areas of the brain are affected by seizures.
Invasive EEG monitoring. If an EEG test with electrodes on the scalp does not show where seizures begin with enough accuracy, monitoring may be done with surgically placed electrodes. Most often the surgeon places electrodes deep inside the brain. This is called stereoelectroencephalography (SEEG) or stereo EEG. Sometimes a surgeon may place grids or strips of electrodes on the surface of the brain.

During an EEG, you likely will be recorded by video camera. Evaluating the changes in your EEG along with your behavior and movements during a seizure helps pinpoint the area of your brain where your seizures start.

For some tests, your care team may reduce or stop your antiseizure medicines for a short time so that seizures can occur. This should only happen while you are in the hospital.

Magnetic resonance imaging (MRI) and other tests

MRI uses a magnetic field and radio waves to create detailed images that help healthcare professionals identify damaged cells or tumors that can cause seizures. MRI can help identify damage to the inner part of the temporal lobe, called mesial temporal sclerosis. It also can help identify brain structures that have formed differently than expected, as well as tumors, trauma or blood vessel issues.

Your surgical team also may order other tests to find the source of seizures and understand the type of irregular brain activity that is causing them. These tests may include:

Positron emission tomography (PET). This specialized imaging device measures brain function when you're not having a seizure. The images alone or combined with MRI data can help identify the source of your seizures.
Single-photon emission computerized tomography (SPECT). This procedure measures blood flow in the brain during a seizure. Typically, blood flow is higher in the part of the brain where seizures occur.

Tests to understand brain function

Your care team may suggest tests to find the exact areas of the brain that control language, sensation, movement or other important functions. This information helps your surgeon protect these functions as well as possible when removing or changing an area of your brain.

The tests may include:

Functional MRI. This test identifies regions of brain activity when you're doing a particular task, such as listening or reading. This helps the surgeon know the exact areas in your brain that control specific functions.
Wada test. With this test, an injected medicine puts one side of your brain to sleep for a short time. This happens with one side of your brain at a time. You then take a test that checks your language and memory abilities. Your team uses these results to understand how surgery might affect your language and memory.
Brain mapping. Small electrodes are surgically placed on the surface of the brain. When you're alert after the surgery, you perform tasks that are matched with measurements of your brain's electrical activity.
Magnetoencephalography (MEG). This test analyzes the magnetic fields produced by the electrical currents in the brain. MEG is used with data from other sources to find seizure sites.

Assessments

Other tests you might have measure verbal and nonverbal learning skills and memory function. These tests may help your healthcare team to better understand the area of the brain affected by seizures. The tests also provide a baseline for measuring brain function after surgery.

Testing also may help your care team learn whether you may be at risk of mood disorders. This includes family or personal history of depression, suicidal behavior, anxiety, or other conditions. This information helps your care team plan your care during and after surgery.

What you can expect

Your care team tells you the steps to follow before surgery. Your care team may decide whether to change your medicine before surgery.

Before the procedure

As you get ready for surgery, a team member may cut your hair or shave your head in places where a cut, called an incision, will be made. You may have one or more incisions in the scalp. More or less hair may be shaved depending on the size or number of incisions.

During the procedure

Epilepsy surgery is usually performed during general anesthesia, so you'll be in a sleeplike state during the procedure. Rarely, your surgeon may wake you up during part of the procedure to help determine which parts of your brain control language and movement. If this happens, you receive medicine to control pain.

The surgeon may create a small opening in the skull, depending on the type of surgery. After surgery, the missing bone is replaced with metal plates and fastened to the skull with screws. These plates and screws are not removed.

In some surgeries, an EEG monitor also may record your brain waves. This can help the care team locate activity near the area where seizures start to help guide the surgery.

After the procedure

After the procedure, you may have a drain in the place where the surgery was performed. This keeps fluid from building up. You have staples and stitches in your scalp. Your head is covered with a dressing. The total hospital stay for epilepsy surgeries is usually about 1 to 4 days depending on the type of surgery.

Your care team tells you when you can wash your head or hair. You may be advised to wait until 48 hours after surgery.

You may have a headache for several days or weeks after surgery. Depending on the location of your surgery, you also may have pain in your jaw. You may notice swelling or bruising around your eye on the side where surgery took place. And you may notice mood swings after surgery.

Most swelling and pain after surgery improve within several weeks. It's common to have a scar from epilepsy surgery. Talk with your care team to understand how your scar may look and what you can expect.

Most people return to work or school after about a month. The timing depends on the type of surgery you have.

You need rest and relaxation for the first few weeks after epilepsy surgery. Your care team can tell you when to increase physical activity.

Rehabilitation may help people who are at risk of having trouble with brain function after surgery. Rarely, this type of care is needed in the hospital immediately after surgery. Rehabilitation can be helpful if strength or other motor functions are affected. If thinking and memory are affected by surgery, then rehabilitation after you leave the hospital may be helpful. This type of rehabilitation often starts after the first stage of recovery from surgery.

Results

After surgery, people generally keep taking antiseizure medicines without changes for at least 1 to 2 years. Over time, a healthcare professional may consider lowering your medicine and may eventually recommend stopping it. But the main goal of epilepsy surgery is to help people with epilepsy stop or reduce seizures, not necessarily to stop or reduce medicines.

The outcomes of epilepsy surgery vary depending on the type of surgery. The expected outcome is better seizure management. Often the goal of surgery is to stop all seizures. In some cases, the goal may be improvement in seizures without an expectation of stopping seizures entirely. Your care team discusses the goals of surgery with you.

The most common procedure removes tissue from the temporal lobe. This procedure results in seizure-free outcomes for about two-thirds of people.

Studies suggest the following outcomes for people who take antiseizure medicine after temporal lobe surgery:

If there are no seizures in the first year, 87% to 90% are seizure-free at two years.
If there are no seizures for two years, 95% are seizure-free at five years and 82% are seizure-free at 10 years.

Some people will continue to have seizures after surgery. Sometimes seizures come back after you've been free of seizures for a time. This can happen for a few reasons. The area of the brain causing the seizure may not have been completely treated or the area was not correctly identified. Or your epilepsy has changed over time. If seizures come back after a period of time of no seizures, an evaluation for another surgery may be suggested for some people.

Research

Mayo Clinic experts trained in neurology, neurosurgery and other areas study genetics, risks, potential diagnostic tests and treatments for epilepsy. Mayo Clinic researchers have developed and studied many diagnostic and treatment tools for epilepsy. They include magnetic resonance imaging, subtraction ictal SPECT coregistered to MRI (SISCOM), electroencephalography, ketogenic diet, deep brain stimulation, epilepsy surgery and many others. Read more about Mayo Clinic research in epilepsy and bioelectronics neurophysiology.

Publications

See a list of publications about epilepsy by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine.