Epilepsy Surgery

Epilepsy surgery is the most effective treatment available for patients with drug-resistant focal epilepsy — defined as failure of two or more appropriately chosen and dosed antiepileptic drugs to achieve sustained seizure freedom. Despite this evidence, epilepsy surgery remains significantly underutilised, with many eligible patients continuing on ineffective medication regimens for years before surgical evaluation is pursued. At SilverOak Health, our epilepsy programme offers comprehensive presurgical evaluation and a full range of surgical interventions.

Presurgical evaluation integrates prolonged video-EEG monitoring to capture habitual seizures, high-resolution MRI brain protocol, interictal and ictal PET or SPECT imaging, neuropsychological assessment, and — when non-invasive data are inconclusive — stereo-EEG (SEEG) with intracranially implanted depth electrodes providing precise three-dimensional mapping of the seizure onset zone. SEEG has transformed surgical candidacy, enabling accurate localisation of seizure networks in patients without an obvious MRI lesion, significantly expanding the proportion of patients who benefit from surgery.

Surgical options include resective surgery (focal cortical resection or temporal lobectomy for mesial temporal sclerosis — the most common and most curable form of drug-resistant epilepsy), laser interstitial thermal therapy (LITT) for deep or eloquent-region foci, corpus callosotomy for refractory atonic drop attacks, and vagal nerve stimulation (VNS) for patients who are not resection candidates. Seizure freedom rates following temporal lobectomy for mesial temporal sclerosis exceed 70% at two years. Our surgical outcomes, morbidity data, and patient-reported quality-of-life measures are prospectively collected and reviewed annually against international benchmarks.