Senior Director - Neurosurgery, Neuro Critical Care & Spine Surgery, Max Super Speciality Hospital, Noida
Part 10 of 10 in Diagnosis & Management of Epilepsy & Seizures
The Multidisciplinary Team Behind Safe Epilepsy Surgery
September 4, 2026
Epilepsy surgery, in Dr. Rattnani's account, is never a single surgeon's unilateral decision, and he describes the sequencing of that decision as deliberately strict.
Who has to be in the room
Nearly every case that reaches the point of considering surgery needs input from four distinct specialists: a neurologist, a neurosurgeon, a neuropsychiatrist and a psychologist. Each has a specific role in assessing whether the patient is a genuine surgical candidate, not just whether a lesion is technically resectable.
Why the sign-off comes before the operating room, not after
The case is discussed with neurology, neuropsychiatry and psychology first, and surgery only proceeds once that team gives its approval. Dr. Rattnani is candid about why this order matters: if a complication does occur, the impact on a patient's quality of life can be serious, and that risk is exactly what the multidisciplinary review is meant to weigh before, not after, the decision to operate.
A globally practiced standard, not an isolated one
This is a standard procedure practiced everywhere a neurosciences centre exists, not a specialty confined to India. Epilepsy surgery is performed in the United States, the United Kingdom and Canada using the same underlying principles, and India alone has at least 40 to 50 centres performing it. The multidisciplinary sign-off Dr. Rattnani describes reflects that same shared, established standard, not a locally invented safeguard.
What this means for a referring doctor
For a doctor referring a patient from outside India, the practical takeaway is straightforward: the assessment does not rest on one specialist's judgment. Sharing a complete EEG and MRI workup starts a process that several specialists, not one surgeon acting alone, will review together before any surgical decision is made.
This article is based on a Jivo Masterclass session conducted by Dr. Dinesh Rattnani, Senior Director - Neurosurgery, Neuro Critical Care & Spine Surgery, Max Super Speciality Hospital, Noida. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a neurosurgery consultation or a second opinion on epilepsy surgery? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Dinesh Rattnani taught doctors across Africa on June 29, 2025.
FROM THE LIVE Q&A
Doctor on the call (name unclear from transcript)
What is the post-operative drug management for these patients?
Dr. Dinesh Rattnani
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.
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Frequently Asked Questions
How does vagal nerve stimulation actually help control seizures?▼
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.
What drug do you prefer, and is robotic surgery an option here?▼
Sodium valproate is the preferred drug of choice. Robotic surgery is still not used at this centre for brain procedures.
Is terahertz wave technology useful in managing epilepsy?▼
This is not something familiar from current practice. Standard advice is to exhaust medical management first, and only refer for surgery once the patient is not responding to it.
Are there advances that could make a patient seizure-free for the rest of their life?▼
That is what everyone in this field is working toward, but it cannot be guaranteed. Sometimes it succeeds, sometimes it does not, and improving long-term seizure freedom remains a continuous, ongoing effort rather than a solved problem.
Based on your experience, what has your success rate been for these surgeries?▼
Around 80% of patients get a desirable result or at least a meaningful reduction in the antiepileptic drugs they need, though a seizure-free or drug-free outcome can never be guaranteed. In 90 to 95% of cases, the surgery at minimum does not make the patient worse. The overall goal is to improve the patient's quality of life from wherever it currently stands, not to promise a cure.
Which specialists are involved in deciding whether an epilepsy patient should have surgery?▼
A neurologist, a neurosurgeon, a neuropsychiatrist and a psychologist, each assessing a different aspect of whether the patient is a genuine surgical candidate.
Does the multidisciplinary team review happen before or after the surgery is scheduled?▼
Before. The case is discussed with neurology, neuropsychiatry and psychology first, and surgery only proceeds once that team gives its approval.
Is epilepsy surgery a standard confined to India?▼
No. It is practiced everywhere a neurosciences centre exists, including the United States, the United Kingdom and Canada, and India alone has at least 40 to 50 centres performing it.
What does a referring doctor need to provide to start this process?▼
A complete EEG and MRI workup, which the multidisciplinary team then reviews together before any surgical decision is made.
In This Series: Diagnosis & Management of Epilepsy & Seizures
- 1.Epilepsy and Seizures
- 2.When Epilepsy Becomes Drug-Resistant: Diagnosis, Workup and When to Refer
- 3.Getting the Diagnosis Right: Why EEG and MRI Concordance Decides Who Is a Surgical Candidate
- 4.Resective Epilepsy Surgery: Temporal Lobectomy and Amygdalohippocampectomy for Mesial Temporal Sclerosis
- 5.Disconnection Surgery: Hemispherectomy and Corpus Callosotomy for the Most Resistant Cases
- 6.Neuromodulation for Epilepsy: How Vagal Nerve Stimulation and Deep Brain Stimulation Work
- 7.Risks, Complications and Realistic Success Rates of Epilepsy Surgery
- 8.Antiepileptic Drug Choices and Post-Surgical Drug Tapering After Epilepsy Surgery
- 9.Can Epilepsy Surgery Make a Patient Completely Seizure-Free? Setting Realistic Expectations
- 10.The Multidisciplinary Team Behind Safe Epilepsy Surgery