Risks, Complications and Realistic Success Rates of Epilepsy Surgery

Sodium valproate and levetiracetam both cover a broad spectrum and rank as the top two choices for most epilepsy types, including generalised tonic-clonic and atonic seizures. For focal seizures with secondary generalisation, carbamazepine is slightly preferred, though sodium valproate also works well. Lacosamide is a newer add-on drug, used alongside a first-line drug rather than as initial therapy. Perampanel is particularly useful when the epilepsy is related to a brain tumour or damaged brain tissue.

No, not at this centre. In neurosurgery, robotic assistance is currently limited to placing spine screws. No brain surgery is done with a robot here, though other centres may use it differently.

The drugs the patient was already on before surgery are continued unchanged for the first 10 to 15 days. After that, one drug is withdrawn at a time, slowly, rather than stopping everything at once. The patient is kept on at least one drug for about a year while seizure-free, and full withdrawal is only considered around the two-year mark, since these are patients who were having seizures despite medication before the operation.

The exact mechanism is not fully understood, but the proposed explanation is that it is a parasympathetic stimulation. Stimulating the vagus nerve sends signals back to the brain, and the brain's electrical activity is reduced as a result. Deep brain stimulation works on a related principle: stimulating the anterior thalamic nucleus also reduces the spread of epileptic activity.

Sodium valproate is the preferred drug of choice. Robotic surgery is still not used at this centre for brain procedures.

5 to 10%, varying by which part of the brain is operated on. The most common complications are infection, bleeding, weakness, hemiparesis or hemiplegia, memory loss, and meningitis.

Hemispherectomy, since it involves disconnecting the largest area of brain tissue of any of the epilepsy procedures Dr. Rattnani performs.

Roughly 5% of cases, where the operation itself proceeds without incident but seizure frequency does not come down as expected.

Around 80% achieve a desirable result, meaning either meaningful seizure control or a reduction in the antiepileptic drugs needed. In 90 to 95% of cases, the surgery at minimum does not leave the patient worse off.

No. Dr. Rattnani is explicit that the reported success rates do not amount to a guarantee of a seizure-free or drug-free outcome. The goal is improving quality of life, not promising a cure.