Epilepsy Surgery & Treatment in Delhi

Epilepsy is one of the most common neurological conditions, affecting millions of people in India. For most, seizures are well controlled with one or two anti-seizure medicines, allowing them to study, work, marry and live normal lives. However, about one in three people with epilepsy continue to have seizures despite trying appropriate medicines. This is called drug-resistant or refractory epilepsy. Ongoing seizures carry real risks - injuries, burns, road accidents, drowning, difficulties with education and employment, social stigma, memory problems and, rarely, sudden unexpected death in epilepsy (SUDEP).

For many people with drug-resistant epilepsy, epilepsy surgery offers the best chance of becoming seizure-free or achieving a major reduction in seizures. Yet it remains underused, often because patients and families are unaware of it or fear brain surgery. Dr. (Prof.) Sumiet Snha, former Professor of Neurosurgery at AIIMS, New Delhi, and Principal Director - Neurosurgery & Spine Surgery at Max Hospital, Dwarka, performs epilepsy surgery as part of a comprehensive epilepsy care team. This page explains who is a candidate, how evaluation is done, the types of surgery and what outcomes to expect.

Understanding Epilepsy

A seizure is a sudden, temporary disturbance in the brain's electrical activity. Epilepsy is diagnosed when a person has a tendency to recurrent, unprovoked seizures. Seizures are broadly classified as:

Focal epilepsies - where seizures arise from a specific brain region - are the ones most likely to be cured by surgery, because removing or disconnecting that region can stop the seizures.

What Is Drug-Resistant Epilepsy?

According to the International League Against Epilepsy (ILAE), epilepsy is considered drug-resistant when seizures continue despite adequate trials of two appropriately chosen and well-tolerated anti-seizure medicines (whether as monotherapies or in combination). Research shows that once two medicines have failed, the chance of becoming seizure-free with further medicines alone is low. That is the point at which referral to a comprehensive epilepsy centre for surgical evaluation should be considered - ideally early, rather than after decades of seizures.

Before labelling epilepsy as drug-resistant, doctors check for "pseudo-resistance": an incorrect diagnosis (for example, fainting or psychogenic non-epileptic seizures), the wrong choice of medicine for the seizure type, inadequate doses, missed doses, or lifestyle triggers such as sleep deprivation and alcohol.

Causes of Drug-Resistant Focal Epilepsy That Respond to Surgery

• Mesial temporal sclerosis (hippocampal sclerosis) - scarring of the hippocampus, the most common cause of drug-resistant temporal lobe epilepsy in adults, often with a history of prolonged febrile seizures in childhood.
• Focal cortical dysplasia - a developmental abnormality of the brain cortex, common in children.
• Low-grade brain tumors - such as ganglioglioma and DNET, which frequently present with seizures.
• Cavernous malformations and other vascular lesions.
• Post-traumatic or post-infectious scars - including scars from old brain infections.
• Tuberous sclerosis and other genetic conditions with identifiable epileptogenic lesions.
• Hemispheric syndromes - such as Rasmussen's encephalitis, Sturge-Weber syndrome or large perinatal strokes causing seizures from one hemisphere.
• Hypothalamic hamartoma - causing gelastic (laughing) seizures.

In India, healed neurocysticercosis (a tapeworm infection) and tuberculomas are also common causes of seizures; most respond to medicines, but a few may cause drug-resistant epilepsy requiring surgical evaluation.

The Pre-Surgical Evaluation - Finding the Seizure Focus

The success of epilepsy surgery depends on accurately identifying where seizures begin (the epileptogenic zone) and ensuring that the area can be removed or disconnected without causing unacceptable new deficits. This is done through a structured, multidisciplinary evaluation:

1. Detailed history and seizure description - including videos of seizures recorded by family on a mobile phone, which are extremely helpful.
2. Video-EEG monitoring - the patient stays in a special unit for several days, with continuous EEG and video recording while medicines may be reduced under supervision to capture typical seizures. The EEG pattern at the start of seizures points to their origin.
3. Epilepsy-protocol MRI (3 Tesla) - thin-slice, high-resolution images specifically designed to detect subtle lesions such as hippocampal sclerosis or focal cortical dysplasia.
4. PET scan - shows areas of reduced metabolism between seizures, which often correspond to the seizure focus.
5. SPECT scan - an injection given during a seizure shows the area of increased blood flow at seizure onset.
6. Neuropsychological assessment - tests memory, language and other cognitive functions to establish a baseline and predict the effects of surgery.
7. Functional MRI and Wada test - to map language and memory functions, particularly in temporal lobe surgery.
8. Psychiatric evaluation - to identify and treat depression or anxiety, which are common in epilepsy.
9. Multidisciplinary case conference - neurologists, neurosurgeons, neuroradiologists, neuropsychologists and psychiatrists review all data together to decide on the best plan.

When non-invasive tests do not agree or the focus is close to critical brain areas, invasive monitoring may be needed. Electrodes are placed on the surface of the brain (subdural grids and strips) or into it through tiny holes (stereo-EEG) to record seizures directly and map brain functions, allowing precise surgical planning.

Types of Epilepsy Surgery

Resective surgery - removing the seizure focus

Disconnection surgery

Minimally invasive and ablative techniques

Laser interstitial thermal therapy (LITT) and radiofrequency thermocoagulation through stereo-EEG electrodes can destroy small, deep seizure foci - such as hypothalamic hamartomas or mesial temporal structures - through a small hole, in selected centres. Stereotactic radiosurgery is another option in specific situations.

Neuromodulation (palliative)

What Results Can Be Expected?

Outcomes depend on the type of epilepsy, the cause and how well the seizure focus is defined:

• Temporal lobe epilepsy with hippocampal sclerosis: a majority of carefully selected patients become seizure-free or nearly seizure-free after surgery. A landmark randomised trial showed that surgery was far more effective than continued medical therapy for drug-resistant temporal lobe epilepsy.
• Lesional epilepsy (tumors, cavernomas, dysplasia): high rates of seizure freedom when the lesion and associated abnormal tissue are completely removed.
• Hemispherotomy: many children with catastrophic hemispheric epilepsy become seizure-free.
• Non-lesional extratemporal epilepsy: lower but still meaningful rates of success, often requiring invasive monitoring.
• Palliative procedures (VNS, callosotomy): reduction in seizure frequency and severity rather than cure.

Even when seizures do not stop completely, a large reduction can greatly improve safety, independence and quality of life. Many seizure-free patients are eventually able to reduce or, in some cases, stop their medicines under the supervision of their neurologist.

Risks of Epilepsy Surgery

Epilepsy surgery is planned to minimise risk, but patients should understand possible complications. These include infection, bleeding, stroke, new neurological deficits depending on the area operated (such as a small visual field loss after temporal lobectomy, which often goes unnoticed), memory or word-finding difficulties (assessed in advance through neuropsychological testing), mood changes and the general risks of anaesthesia. The pre-surgical evaluation aims to predict and minimise these risks. It is also important to weigh them against the substantial risks of continuing uncontrolled seizures.

Recovery After Epilepsy Surgery

Epilepsy Surgery in Children

Children deserve special attention. Frequent seizures during the years when the brain is developing rapidly can seriously affect learning, behaviour and development - a process called epileptic encephalopathy. Conditions such as focal cortical dysplasia, tuberous sclerosis, hemimegalencephaly, Rasmussen's encephalitis and perinatal strokes often cause drug-resistant epilepsy in childhood. Early surgery, when appropriate, can stop seizures and allow development to catch up. The young brain's remarkable plasticity means that children often recover function after surgery better than adults. Referral for evaluation should not be delayed in children whose seizures are not controlled with two medicines.

Common Myths About Epilepsy Surgery

• Myth: Surgery is a last resort after all medicines have failed. Fact: Surgery should be considered once two appropriate medicines have failed - earlier surgery often gives better results.
• Myth: Epilepsy surgery will damage intelligence. Fact: Careful evaluation predicts and minimises cognitive risk; stopping seizures often improves cognition and behaviour.
• Myth: Epilepsy is a mental illness or caused by supernatural forces. Fact: Epilepsy is a neurological condition with medical causes and effective treatments.
• Myth: People with epilepsy cannot marry or have children. Fact: Most people with epilepsy lead normal family lives; women can have healthy pregnancies with planning.

Seizure First Aid - What Everyone Should Know

• Stay calm and note the time the seizure starts.
• Protect the person from injury - move hard or sharp objects away and cushion the head.
• Turn them gently onto their side (recovery position) once the jerking stops, to keep the airway clear.
• Do not put anything in the mouth, do not hold the person down, and do not give water or medicines by mouth during the seizure.
• Do not use shoes, onions or keys - these traditional remedies do not help and can cause harm.
• Stay with the person until they are fully awake and oriented.
• Call emergency services if a seizure lasts longer than 5 minutes, if seizures repeat without recovery in between, if the person is injured, pregnant or has trouble breathing, or if it is their first seizure.

Why Choose Dr. (Prof.) Sumiet Snha for Epilepsy Surgery?

Factors That Affect the Cost of Epilepsy Surgery

• Extent of pre-surgical evaluation - video-EEG, PET, SPECT, invasive monitoring.
• Type of surgery - resection, disconnection, ablation or VNS implantation.
• Hospital and ICU stay.
• Device costs for neuromodulation.
• Insurance coverage.

Living With Epilepsy - Safety and Wellbeing

While treatment is being optimised, simple safety measures reduce the risk of injury. Showers are safer than baths, and bathroom doors should not be locked. Avoid swimming alone and working at heights or near open fires and machinery until seizures are controlled. Cook using the back burners of the stove, and consider guards for heaters. Get enough sleep, as sleep deprivation is one of the most common seizure triggers, and avoid excessive alcohol. Keep a seizure diary - noting date, time, type, possible triggers and missed doses - which helps your doctors fine-tune treatment. Medicines should never be stopped suddenly, as this can trigger severe or prolonged seizures.

Epilepsy also affects emotional wellbeing. Depression and anxiety are more common in people with epilepsy, and they deserve treatment in their own right. Stigma and misconceptions can lead to isolation, especially for young people and women. Open conversations with family, teachers and employers, along with support groups, help people with epilepsy live with confidence.

Women, Pregnancy and Epilepsy

Most women with epilepsy have healthy pregnancies and healthy babies. Planning ahead is important: some anti-seizure medicines carry a higher risk of birth defects or developmental effects and may be changed before conception under the guidance of a neurologist. Folic acid supplementation is recommended before and during pregnancy. Seizure control should be optimised, because uncontrolled convulsive seizures can harm both mother and baby. For women with drug-resistant epilepsy who hope to start a family, surgical evaluation before pregnancy may offer the chance of better seizure control with fewer medicines.

Neurocysticercosis and Seizures in India

Neurocysticercosis - infection of the brain by the larval form of the pork tapeworm - is one of the most common causes of acquired epilepsy in India. Cysts may appear on CT or MRI as small ring-enhancing lesions or calcified dots. Most patients respond well to anti-seizure medicines, sometimes combined with anti-parasitic drugs and steroids, and seizures often stop as the cyst resolves. A small number continue to have seizures from a calcified scar and may be evaluated for surgery if the scar is clearly the seizure source. Prevention through good hygiene, washing vegetables thoroughly and eating well-cooked pork helps reduce infection.

Temporal Lobe Epilepsy - The Most Treatable Form

Temporal lobe epilepsy is the most common type of focal epilepsy in adults and the one most frequently cured by surgery. The temporal lobes, located on each side of the brain behind the temples, contain the hippocampus and amygdala - structures involved in memory and emotion. When the hippocampus becomes scarred (mesial temporal sclerosis), it can become a persistent source of seizures. Many patients describe a characteristic "aura" at the start of their seizures: a rising, churning feeling in the stomach, a sudden sense of fear, a strong feeling of familiarity (déjà vu) or unfamiliarity, or an unusual smell or taste. This may be followed by staring, unresponsiveness, lip-smacking, fumbling with the hands or chewing movements, after which the person is confused and may not remember the event. Some seizures spread to become generalised convulsions.

Because the seizure source is often well defined and the operation is highly standardised, temporal lobe surgery has one of the best success rates in all of epilepsy surgery. The procedure involves removing the front part of the temporal lobe along with the hippocampus and amygdala, or a more selective removal of the mesial structures alone. The pre-surgical evaluation carefully assesses memory function on each side. When surgery is performed on the side of the brain that is less dominant for memory and language, the risk of noticeable memory decline is lower. Where the risk is higher, the team discusses it openly and may modify the surgical plan. Many patients report that their overall memory and concentration actually improve once frequent seizures and the side effects of multiple medicines are reduced.

Long-term follow-up studies show that most patients who become seizure-free in the first year after temporal lobe surgery remain seizure-free in later years. Freedom from seizures brings freedom in daily life: the ability to drive once legally permitted, better employment prospects, greater independence, improved mood and relationships, and a reduced risk of injuries and sudden death related to epilepsy.

The Emotional Journey of Choosing Surgery

Deciding on brain surgery for epilepsy is a major step. Patients often have lived with seizures for many years and have adapted their lives around them. The idea of an operation can feel frightening, even when seizures are frequent and disabling. It is natural to have questions and doubts. A good epilepsy surgery programme takes time to explain the findings of each test, the reasons for recommending (or not recommending) surgery, the expected chance of seizure freedom and the specific risks for that individual. Meeting other patients who have undergone surgery can be reassuring. Families are encouraged to participate in discussions, since their support is vital during recovery. Ultimately, the decision rests with the patient and family, and the team supports whichever path they choose.

Focal Cortical Dysplasia and Epilepsy in the Young

Focal cortical dysplasia (FCD) is an area of the brain's surface where the nerve cells did not organise normally during development. It is one of the most common causes of drug-resistant epilepsy in children and young adults. Seizures often begin in early childhood, can occur many times a day, frequently arise from sleep, and may not respond to multiple medicines. Some dysplasias are clearly visible on MRI, while others are subtle and need specialised epilepsy-protocol imaging, PET and careful review by experienced neuroradiologists to detect. When the dysplasia is identified and can be completely removed, the chance of seizure freedom is good. In cases where it lies near areas controlling movement or language, brain mapping during surgery or with implanted electrodes helps remove as much abnormal tissue as possible while protecting function.

Vagus Nerve Stimulation - An Option When Resection Is Not Possible

Not every person with drug-resistant epilepsy has a single, removable seizure focus. Some have seizures arising from multiple areas or from both sides of the brain, and others have foci in regions that cannot be removed safely. For these patients, vagus nerve stimulation provides a valuable option. A small generator is implanted under the skin below the collarbone, and a thin lead is wrapped around the left vagus nerve in the neck through a separate small incision. The device delivers regular, mild electrical pulses, and patients or carers can swipe a magnet over it to deliver extra stimulation at the start of a seizure, which may stop or shorten it. Benefits usually build up gradually over months to years. Many patients experience a meaningful reduction in seizure frequency and severity, shorter recovery after seizures, and improved alertness and mood. Side effects are generally mild and related to stimulation - such as hoarseness, cough or a tingling sensation in the throat during stimulation - and often lessen over time or with adjustment of settings.

Questions to Ask Your Epilepsy Team

• Is my epilepsy truly drug-resistant, and has the diagnosis been confirmed with video-EEG?
• Does my MRI show a lesion, and is it likely to be the source of my seizures?
• What tests do I need, and will I need invasive monitoring?
• What is my estimated chance of becoming seizure-free with surgery?
• What are the specific risks to my memory, language, vision or movement?
• How long will I need to continue medicines after surgery?
• If I am not a candidate for resective surgery, would VNS or another option help?

Seizures and Epilepsy in Older Adults

Epilepsy is often thought of as a condition of childhood, but the chance of developing seizures rises again in later life. In people over 60, new seizures frequently have an identifiable cause, such as a previous stroke, a brain tumour, a head injury from a fall, or degenerative brain conditions. Seizures in older people can also look different: rather than dramatic convulsions, they may appear as brief episodes of confusion, staring, unexplained falls or memory gaps, and are sometimes mistaken for fainting, transient ischaemic attacks or dementia.

Special considerations in treatment

• Finding the cause: MRI and EEG are important, because a treatable lesion such as a tumour or chronic subdural haematoma may be responsible.
• Medicine choice: older adults are often taking several medicines, so anti-seizure drugs are chosen to minimise interactions, drowsiness, unsteadiness and effects on bone health.
• Lower doses: changes in kidney and liver function may mean smaller doses work well.
• Fall prevention: home safety measures reduce injury if a seizure occurs.

Is surgery possible in later life?

Age alone does not rule out epilepsy surgery. An older adult whose seizures come from a clearly defined lesion - for example a tumour, cavernoma or area of old injury - and who continues to have seizures despite appropriate medicines may still benefit from carefully selected surgery, provided general health allows safe anaesthesia. Equally, people who have lived with drug-resistant epilepsy since youth sometimes reach their forties or fifties without ever being evaluated. It is rarely too late to ask whether surgery might help. Dr. Snha assesses each person individually, weighing the likely benefit against medical risks, and works with neurologists to agree a plan that suits the patient and family.

Frequently Asked Questions

Don't Let Seizures Control Your Life

If seizures continue despite medicines, ask whether you might be a candidate for epilepsy surgery. Book a consultation with Dr. (Prof.) Sumiet Snha at Max Hospital, Dwarka, New Delhi, to discuss evaluation. Related pages: brain tumor surgery, cavernoma and AVM treatment and paediatric neurosurgery.