The presurgical evaluation comes first
Specialist epilepsy centers combine several types of evidence to identify where seizures start and how close that area is to critical brain functions. Surgery should not be planned from MRI alone or from the seizure description alone.
- Long-term video-EEG monitoring
- High-resolution structural MRI
- Neuropsychological testing
- Functional imaging such as PET or SPECT in selected cases
- Functional mapping when relevant
- Invasive EEG monitoring if non-invasive tests do not answer the key questions
Surgery can mean different procedures
The operation depends on the seizure focus, brain function and treatment goal. Freiburg describes a broad spectrum ranging from temporal and extratemporal resections to minimally invasive thermotherapy, disconnection procedures and neurostimulation.
- Temporal or extratemporal resection
- Selective amygdalohippocampectomy in appropriate cases
- Laser interstitial thermotherapy (LITT) for selected lesions
- Stereotactic thermocoagulation in selected cases
- Hemispherotomy or other disconnection surgery in selected severe epilepsies
- Vagus nerve stimulation or other neuromodulation when resection is not appropriate
The goal must be defined before treatment
For some patients the aim may be seizure freedom; for others the realistic goal is seizure reduction or prevention of the most dangerous seizure types. The expected benefit and neurological risks depend strongly on the individual epilepsy network and the operation proposed.
What to send for an international second opinion
A specialist center needs the raw evidence behind the diagnosis, not only a short referral letter.
- Seizure history and current seizure frequency
- Anti-seizure medications tried and reasons for stopping them
- Previous video-EEG reports
- MRI images and radiology reports
- PET/SPECT or neuropsychological reports if performed
- Previous surgery or stimulation reports
- A clear question about candidacy or next diagnostic steps
Do not delay urgent local care
A planned epilepsy-surgery review is not a substitute for emergency assessment of prolonged seizures, repeated seizures without recovery, injury or other acute deterioration. Urgent symptoms should be managed through local emergency services first.
Official sources
Sources last checked 2026-08-29. Clinical pathways, eligibility and hospital procedures can change; confirm current requirements directly with the treating center.