Early surgery for seizures may also be recommended if the cause of seizures is identified to be a brain lesion that is growing, such as a tumour.

For most children, medication is all that is needed to control seizures. However, some children continue to have seizures even after trying two or more different medications or a combination of medications. Seizures that fail to respond to two or more anti-epileptic drugs are called medically refractory seizures.

When medication fails to control seizures, surgery (an operation) may be considered to remove or disconnect the part of the brain that is generating the seizures. This is called the epileptogenic (seizure-causing) region of the brain.

With improvements in imaging technology and EEGs, it is now easier for doctors to define the epileptogenic areas of the brain. As a result, surgery has become a well-established method of treatment.

All children with epilepsy that cannot be controlled with medication should be considered for surgery. There appear to be some advantages to doing epilepsy surgery in children, rather than waiting for adulthood:

• Children's brains are more plastic than adults' brains, with a greater ability to compensate for portions removed during surgery.
• In some children, treating seizures earlier may prevent brain damage or changes from repeated seizures and their detrimental effects on cognition and development.

Early surgery for seizures may also be recommended if the cause of seizures is identified to be a brain lesion that is growing, such as a tumour.

Although surgery will not help every child with uncontrolled seizures, it can be a very effective treatment. Various studies suggest that 57% to 69% of babies, children, and teenagers treated with surgery become seizure-free. Between 11% and 24% continue to have frequent seizures.

This page contains an overview of the surgical process, from determining whether your child is a candidate for surgery to post-operative care. You will find more detail about each step and each surgical procedure in the other pages in this section

Who is surgery considered for?

Surgery for epilepsy is considered when:

• The child has seizures that will not improve by themselves as the child gets older.
• Drugs have been tried and have failed to control a child's seizures. Often at least two individual medications separately (monotherapy) and one combination of medications (polytherapy) will have been tried and will have failed to control seizures.
• The epileptogenic or seizure-causing region of the brain can be clearly identified and can be removed or disconnected with minimal risk of harming the child.

With advances in knowledge and technique in both diagnostic tools and surgery, broader spectrums of people with epilepsy are now being considered for surgery.

Determining whether your child is a candidate for surgery

Not every child with intractable epilepsy is a good candidate for surgery. Some children may be ruled out based on their history and EEG.

If your child's history and EEG suggest that surgery may be helpful, a detailed pre-surgical evaluation will be done and the results will be thoroughly analyzed to determine:

• whether your child will be helped by surgery
• the type and exact location of the operation

The pre-surgical evaluation may consist of one or more procedures.

Making a decision about surgery

If the doctors determine that surgery is an option for your child, you should discuss it with the doctor and with your child (if your child is old enough) and think the decision over carefully. You will need to consider the possible improvements from the surgery, the risks of surgery, the risks if your child does not have the surgery, and any alternative treatments.