Individuals of any age who meet the criteria for drug-resistant epilepsy (defined as failure to achieve seizure freedom after using two or more anti-seizure medications) are considered surgical candidates and are eligible for assessment. Epilepsy surgery is complex and differs between each individual.
Three Main Goals of Epilepsy Surgery
- Seizure freedom (no seizures) or reduce seizures
- Improve quality of life
- Ability to decrease or stop anti-seizure medications use
The likelihood of successful seizure control will be discussed with you by your loved one’s surgeon. Several factors influence the outcome of the surgery, including:
- The underlying cause of the seizures.
- The duration of the individual’s seizure history.
- The normal development of other brain regions.
Types of Epilepsy Surgery
Epilepsy surgery is categorized as either curative or palliative. Curative surgery aims to completely stop the individual’s seizures by removing the brain region that seizures originate from. This option is not always suitable if seizures originate from multiple, separate areas in the brain or if doctors cannot safely isolate or remove the area of the brain causing the seizures. Palliative surgery is performed to reduce the frequency of seizures, though it usually does not eliminate them entirely.
Before considering other surgical options with a neurosurgeon, a comprehensive epilepsy surgery evaluation is essential. This evaluation should take place at a hospital with extensive expertise relevant to your loved one’s age, the cause of their seizures, and the specific surgery type being considered.
The experience levels of the neurologists, epileptologists, and neurosurgeons can vary significantly between hospitals. Some institutions may have greater specialization in a particular type of surgery than others. Brain surgery on a child requires a surgeon who is familiar with the challenges of operating on a child.
Epilepsy Surgery Options
Laser interstitial thermal therapy (LITT) uses light and heat to destroy (ablate) the part of the brain that causes seizures. During the surgery, magnetic resonance imaging (MRI) is used to map the exact area for treatment, then a laser is used to target the treatment area. This is done without needing to open the skull, making it a minimally invasive procedure with shorter hospital stays.
A lobectomy or lobe resection is a surgical procedure in which one or more lobes of the brain are removed.
Hemispheric surgeries disconnects one half of the brain (hemisphere) from the other. These surgeries are typically reserved for individuals whose seizures originate from a very large area on one side of the brain.
This surgery cuts the fibers connecting the two halves of the brain to stop seizures from spreading. Effectiveness across multiple seizure types including atonic and tonic most notably, but also generalized tonic-clonic and absence. As a palliative procedure, callosotomies can provide seizure reduction of greater than 50%.
Neuromodulation technology works by sending gentle electrical signals to specific nerves through a small device surgically placed in the body. The three most common types used in LGS are Vagus Nerve Stimulation (VNS), Responsive Neurostimulation (RNS), and Deep Brain Stimulation (DBS). All three help reduce seizures without removing or damaging any part of the brain, and they often become more effective over time. The main difference between them is simply where the device is placed in the body. Nearly 70% of individuals experience a more than 50% reduction in overall seizure frequency.
VNS uses a small device placed under the skin on the left side of the chest. A thin wire connects it to the vagus nerve in the neck, which runs from the brain down to the heart and digestive system. The device sends gentle electrical pulses along this nerve to the brain on a regular schedule, helping reduce how often seizures happen and how severe they are. Caregivers can also deliver an on-demand dose of stimulation to abort seizures as a form of rescue. More than half of people who use VNS see improvement.
RNS works like a "brain pacemaker." A small device is placed inside the skull and connected to thin wires in the part of the brain where seizures start. It continuously monitors brain activity and sends a quick electrical pulse to potentially stop a seizure before symptoms even appear. FDA-approved for adults 18 and older, it is still being investigated for pediatric use in LGS, but early results are promising. In a small sample size (10) of individuals, 60% were shown to be responders (defined as a ≥ 50 % reduction in seizures).
DBS sends electrical signals to a precise location deep in the brain to help prevent seizures. A small electrode is placed in the brain, connected to a pacemaker-like device in the chest or belly. Unlike RNS, DBS runs on a set schedule rather than responding to individual seizures. It can also record brain activity to help guide future treatment decisions. A systematic review showing a mean seizure reduction of 63%, with 81% of patients achieving significant seizure control, though seizure freedom remains rare.
- Is LGS Surgery and/or Neuromodulation Right for My Loved One?
- LGS Surgery Overview by Dr. Scott Perry
The information here is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. The content provided is for informational purposes only. LGS Foundation is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options.
Updated 08/11/26 (KK)