Disconnection Surgery: Hemispherectomy and Corpus Callosotomy for the Most Resistant Cases

Yes. Get the EEG and MRI done, share the reports, and the surgical team will review them and advise from there.

The best candidates are cases with good concordance between where the seizure semiology points, what the MRI shows, and what the EEG confirms, for example a right temporal lobe abnormality on MRI matching a right temporal EEG focus. Temporal lobe epilepsy accounts for 70 to 80% of these good-responder cases, typically treated with temporal lobectomy along with amygdalohippocampectomy. Teenagers can absolutely undergo the surgery, but medical management is always tried first.

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 After that, one drug is withdrawn at a time, slowly, rather than stopping everything at once.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.

Surgery that does not remove the tissue generating seizures, but instead cuts the pathways that let seizure activity spread from a focal point into a full, generalized seizure.

No. It disconnects the frontal lobe from the temporal, parietal and occipital lobes at specific points so a seizure cannot spread across the hemisphere, without removing all the tissue in it.

Not as a default outcome. The disconnection avoids the corticospinal tracts controlling voluntary movement and stays within the white matter, which is mostly sensory.

No. Continued medication is still needed afterward, though seizures can usually be controlled better with the combination of surgery and drugs than with drugs alone.

It targets atonic seizures specifically, disconnecting the pathway that allows seizure spread, though it is far less commonly performed today than resective or neuromodulation approaches.