A seizure lasting more than five minutes, or repeated seizures without recovery between them, is an emergency. Call an ambulance. Also seek urgent care after any first seizure, or a seizure with injury, breathing difficulty or failure to wake.
Seizures that continue despite two properly chosen and properly dosed medications. At that point further drugs are unlikely to work, and surgery becomes a serious option that far too few patients are offered.
The average delay between developing drug-resistant epilepsy and being assessed for surgery is measured in years, in every country. If you have had seizures despite two medications, the evaluation is worth pursuing now rather than trying a third.
Epilepsy is defined as drug-resistant when seizures continue despite adequate trials of two appropriately selected and properly dosed anti-seizure medications. This definition matters because it identifies the point at which the odds change: after two failures, the chance that a third drug achieves seizure freedom is small, while surgery in well-selected patients achieves it in a substantial majority.
The commonest surgically treatable form is temporal lobe epilepsy, frequently associated with scarring in the hippocampus visible on MRI. Where a clear structural cause is identified and matches the seizure pattern on EEG, surgical outcomes are at their best.
In regions where our patients travel from, two additional causes are important. Neurocysticercosis, a parasitic infection, is among the commonest causes of adult-onset seizures in endemic areas, and it is treated medically. Old tuberculomas and their calcified remnants can also generate seizures. Both should be considered before any surgical pathway is entered.
The pre-surgical evaluation, rather than the operation itself, is what requires a specialised centre. Video EEG monitoring over days, high-resolution epilepsy-protocol MRI, PET scanning, neuropsychological assessment and sometimes electrodes placed directly on or in the brain are needed to localise the seizure origin with confidence.
This is the most important message on the page. Once two appropriately chosen medications have failed at adequate doses, the probability that a third achieves seizure freedom is low, while surgery in carefully selected patients achieves it in the majority. Yet the average delay before referral is many years in every health system, during which patients continue to have seizures, injuries and restrictions on driving and work. If you have failed two drugs, ask for a referral to an epilepsy surgery centre rather than a further prescription.
The evaluation is extensive by design, because localisation must be certain before any brain tissue is removed.
This is genuinely the most useful document you can send. A drug tried at too low a dose, or stopped because of a rash rather than because it failed, has not truly failed. Establishing whether you are actually drug-resistant is the first step, and it depends on an accurate record. Send the drug names, maximum doses reached, how long each was taken and why it was stopped, along with your MRI and EEG reports and a description of what a typical seizure looks like.
The evaluation determines whether surgery is possible and which operation applies.
Before any surgical pathway, the diagnosis is confirmed — some events referred as epilepsy are not seizures at all — and drug treatment is reviewed. Correct drug selection for the seizure type, adequate dosing, and treating a remediable cause such as neurocysticercosis can achieve control without surgery in some patients.
Removal of the region generating seizures — most commonly a temporal lobectomy with removal of the hippocampus, or a focal resection of a lesion elsewhere. In well-selected patients, particularly temporal lobe epilepsy with a visible abnormality, a substantial majority become seizure-free or nearly so.
Where removal is unsafe, connections carrying seizure spread can be divided — corpus callosotomy for drop attacks, or multiple subpial transection. Laser ablation destroys a small deep focus through a tiny opening with much faster recovery than open surgery.
Vagus nerve stimulation, and in some centres responsive or deep brain stimulation, reduce seizure frequency where no single focus can be identified or removed. These reduce seizures rather than eliminating them, and that expectation should be set clearly.
Two adequate trials of appropriate drugs. Inadequate dosing or the wrong drug for the seizure type is not resistance.
Video EEG, MRI, PET and neuropsychology must agree. Where they do not, invasive recording may be needed before any resection.
Neuropsychological assessment predicts effects on memory and language. In dominant temporal lobe surgery this is a real consideration and must be discussed beforehand.
If your seizures began in adulthood and you come from a region where neurocysticercosis is common, we will want that excluded before any surgical pathway. It is treated with medication.
Prolonged or clustering seizures need stabilising locally before travel. Video EEG evaluation deliberately reduces medication and must happen in a monitored unit, never during a journey.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
The starting point is whether two appropriately chosen medications have failed at adequate doses. If so, evaluation is warranted. Candidacy is then determined by whether seizures arise from a single localisable area that can be removed safely. Temporal lobe epilepsy with a visible abnormality on MRI has the best outcomes, but many other patterns are also treatable.
Admission for video EEG monitoring over several days with medication reduced so that seizures can be recorded, a high-resolution epilepsy-protocol MRI, often PET scanning, and neuropsychological testing. Where these do not agree, electrodes may be placed on or into the brain for direct recording. The evaluation is the reason to travel to a specialised centre — it cannot be improvised.
In well-selected patients it frequently achieves seizure freedom, particularly in temporal lobe epilepsy with a clear structural cause. Most patients continue medication for at least two years afterwards, and some indefinitely. Outcomes vary considerably by epilepsy type, which is exactly what the evaluation establishes before anyone commits to an operation.
It carries real risks — infection, bleeding, visual field loss with temporal surgery, and effects on memory or language depending on the side and site. Neuropsychological assessment beforehand predicts what may be affected, and this should be discussed frankly. For someone having frequent seizures with injuries and no independence, those risks are frequently worth accepting.
It is worth checking, particularly for patients from South Asia and parts of Africa and the Middle East. Neurocysticercosis is among the commonest causes of adult-onset seizures in endemic regions and is treated with medication. Old tuberculomas can also cause seizures. Both should be excluded before a surgical pathway is entered.
Yes, and in appropriate cases earlier is better — uncontrolled seizures in a developing brain affect learning and development, so waiting has a cost of its own. Certain childhood epilepsy syndromes respond very well to surgery. The evaluation follows the same principles with paediatric expertise added.
Send your MRI and EEG reports along with a full list of every drug tried, the maximum dose reached, and why each was stopped. That list decides the first question.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.