Temporal lobe epilepsy causes reoccurring seizures that arise from the temporal lobe on one side of your brain. Surgery may be an effective treatment option for those with temporal lobe epilepsy that doesn’t respond to medications.
About one-third of people who have focal epilepsy have temporal lobe epilepsy. The first-line treatment is usually antiseizure medications, but about a third of people don’t respond to these. Surgery is an effective treatment option for temporal lobe epilepsy in about 60–70% of people who don’t respond to medications.
Because individuals who have surgical treatment for temporal lobe epilepsy surgery are carefully screened and selected, the success rates are generally high and there are fewer risks. But a small number of people may experience some short-term and long-term difficulties related to the surgery.
Surgery for temporal lobe epilepsy can involve removing tissue or creating a lesion (wound) in your temporal lobe and surrounding brain areas to stop seizure activity.
The most common surgery used to treat temporal lobe epilepsy is an anterior temporal lobectomy with amygdalohippocampectomy. This procedure involves removing:
If your seizures are affecting your quality of life and antiseizure medications haven’t helped, a doctor may recommend an evaluation to see if you might benefit from surgery.
According to the Epilepsy Foundation, almost a third of people don’t respond to medications.
The surgical team can give you the best idea of what will happen during your procedure.
Here’s an overview of what you might expect during one of these types of surgery:
- Your hair will be shaved around the surgical site.
- You’ll receive a general anesthetic intravenously (through an intravenous [IV] line). The IV line is usually inserted into a vein in your arm. After receiving a general anesthetic, you’ll be in a state of nonfeeling and unawareness so that you don’t feel any pain.
- An incision will be made over your ear. A piece of your skull will be removed so that your surgeon can access your brain.
- They’ll then carefully remove part of your temporal lobe, amygdala, and hippocampus.
- Once the brain tissue is removed, the surgeon will replace the piece of your skull and close your skin with stitches.
Since there are several types of temporal lobe epilepsy surgery, the length of surgery can vary. If less invasive methods are used, the surgery may be quicker. If open surgery is necessary, surgery may take longer.
On average, temporal lobe epilepsy surgery usually takes between 3–4 hours.
Before the procedure, you’ll receive tests to make sure surgery is likely to be safe and effective. These tests may include:
- blood tests
- video electroencephalogram, which may require a hospital stay of 3–10 days
- electroencephalogram at home
- imaging tests such as:
- psychiatric evaluation
- tests to assess your:
- thinking ability
Presurgical testing has two goals. One is to determine whether the surgery is likely to be effective, which relies on identifying where the seizures are coming from in the brain and if it’s just one area that can be removed or ablated.
The other is to determine whether you’d lose important brain functions after this seizure-causing area is removed or ablated during surgery.
The night before or the morning of the procedure, you’ll need to have a bath and wash your hair with a special soap.
You’ll have a bandage wrapped around your head when you leave the operating room. You may also have a clear plastic tube coming out of the bandages for the first 24 hours to help remove fluid.
As many as 70% of people are seizure-free after having surgery to treat temporal lobe epilepsy. Even at follow-ups longer than 20 years, researchers have reported that around 65% of people remain seizure-free.
In a 2022 study from Brazil, researchers reported a short-term complication rate of 13% and a long-term complication rate of 13.5% among 621 people treated at one clinic from 1994–2011.
There are many possible short-term and long-term risks following temporal lobe epilepsy surgery. Aside from seizures, which may affect around
Long-term risks may include:
- double vision
- language disorder
- cerebral spinal fluid fistula
- psychiatric disorders
- chronic headaches
- movement difficulties
Short-term risks may include:
What is the survival rate for temporal lobe surgery?
The vast majority of people who have temporal lobe surgery survive. In a 2017 study, researchers found that the mortality rate for people after temporal lobectomy was 1.4%.
What are the effects of temporal lobe epilepsy surgery?
Temporal lobe epilepsy can potentially stop temporal lobe seizures. But surgery isn’t always effective.
How many medications should I try before considering surgery?
Many people need to try two or three types of antiseizure medications before finding one that works.
What happens if surgery fails?
If surgery doesn’t completely stop your seizures, you’ll need to continue taking any prescribed medications. A combination of surgery and medications may be effective when seizures aren’t controlled with just one of these.
Surgery is a treatment option for temporal lobe epilepsy that doesn’t respond to antiseizure medications. Most temporal lobe epilepsy surgery involves making a small lesion in the seizure focus on the temporal lobe of your brain, but surgery may involve removing part of the temporal lobe as well as the amygdala and hippocampus.
Many people become seizure-free after surgery, but the procedure may involve some risks. Your surgical team can best advise you on the potential benefits and risks.