Epilepsy surgery
Most people with epilepsy respond well to anti‑epileptic medication. They become seizure‑free or have far fewer seizures. However, in about one out of three people, at least two correctly chosen medications do not work well enough. This is called drug‑resistant (refractory) epilepsy.
When someone has drug‑resistant epilepsy, it is important that they are referred to a specialized epilepsy centre, such as University Hospitals Leuven (UZ Leuven). At the centre, doctors perform detailed testing to understand why seizures continue and which additional treatments may help, including epilepsy surgery.
What is epilepsy surgery?
Epilepsy surgery aims to remove the area of the brain where seizures begin, but only if this can be done safely — without damaging important functions such as movement, speech, or memory.
Which tests are needed?
Before doctors can decide whether surgery is possible, several tests are required to identify exactly where seizures start and which treatment is safest.
At UZ Leuven, this evaluation usually includes:
1. Long‑term video‑EEG monitoring with SPECT
During a hospital stay, seizures are recorded using video and EEG.
This helps the team see how a seizure begins and which brain areas become active.
Learn more about video‑EEG Learn more about SPECT
2. High‑resolution MRI scan
This scan is performed using special epilepsy protocols.
Its goal is to find any brain abnormalities that might be causing seizures.
Sometimes, the images are also analysed using AI‑based techniques to detect very subtle changes.
3. PET scan
A PET scan shows how much sugar (glucose) different parts of the brain use.
Areas where seizures start often use less glucose, which helps locate the seizure onset zone.
4. Neuropsychological assessment
A neuropsychologist evaluates thinking skills, memory, behaviour, and emotions.
This helps identify cognitive strengths and weaknesses, and whether surgery could pose a risk to certain abilities.
Learn more about neuropsychological assessment
How is the decision made?
All test results are reviewed by a multidisciplinary team that includes child neurologists, neuropsychologists, neuroradiologists, nuclear medicine specialists, psychiatrists, and neurosurgeons.
Together, they decide whether a patient is a good candidate for epilepsy surgery.
Are additional tests sometimes needed?
In some cases, the information from the standard tests is not complete.
The team may then recommend additional investigations, such as:
Magnetoencephalography (MEG)
A very precise test that measures brain activity through tiny magnetic signals.
Intracranial EEG (iEEG)
For some children, electrodes must be placed on or inside the brain (intracranial) to determine exactly where seizures begin.
This can be done using stereo‑EEG (preferred because it carries fewer risks) or subdural grids/strips.
After these extra tests, all information is reviewed again, and the team decides whether epilepsy surgery is both possible and safe.
What if epilepsy surgery is not an option?
Not everyone is eligible for epilepsy surgery. In some cases, doctors may recommend other surgical or device‑based treatments, such as:
- Vagus Nerve Stimulation (VNS)
A device similar to a pacemaker that helps reduce seizure frequency and severity.
Learn more about VNS - Thermocoagulation
A technique that uses heat to disable small areas of brain tissue involved in seizures. - Laser Interstitiële Thermale Therapie (LiTT)
A minimally invasive laser treatment that targets a specific area of the brain very precisely.
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