| This is an issue of education and fear of the high cost of the surgery. This cost can approach $50,000. Economic analyses taking into account the direct medical costs of uncontrolled seizures indicate that the money can be recovered in 5 - 10 years after successful seizure surgery. If individuals then can go back to work, lead a more normal life, and start paying their own share of life expenses, then costs are recovered even more quickly.
Epilepsy surgery is elective; no person should be pushed into having epilepsy surgery. Surgery may, however, be the best way to eliminate seizures in a particular individual.
When should people be referred for seizure surgery? This is an individualized decision. Seizure surgery is considered when a person is known to have definite epilepsy (not one of the imitators), a reasonable likelihood that the seizure onset is focal and limited to one part of the brain.
The candidate must be motivated for surgery, and be able to argue that reduction of seizures will make a difference in her or his life. The surgical candidate and family should understand the risks that can be in the range of a two percent chance for a serious surgical complication. Medication therapy should have been ineffective, defined as failure of a good trial of several standard seizure medicines, under guidance of a doctor familiar with epilepsy.
People with epilepsy should recognize that the new medications are not a replacement for epilepsy surgery, because only very rarely does a new medicine render a patient seizure-free. New medications can reduce the seizure frequency, reduce the intensity of the seizures, eliminate secondary generalization of seizures, and allow an adjustment of medications to give a better side effect profile.
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