A study published in 2000 compared epilepsy surgery to an additional year of treatment with antiepileptic drugs in people with longstanding temporal lobe epilepsy. The results showed that 64 percent of patients receiving surgery became seizure-free, compared to 8 percent of those who continued with medication only.
Because of this study and other evidence, surgery for temporal lobe epilepsy is now recommended when antiepileptic drugs are not effective. However, there is not guidance on how long seizures should occur, how severe they should be, or how many drugs should be tried before surgery is considered. A nationwide study is now underway to determine how soon surgery for temporal lobe epilepsy should be performed.
If a person is considered a good candidate for epilepsy surgery and has seizures that cannot be controlled with available medication, experts generally agree that surgery should be performed as early as possible.
It can be difficult for a person who has had years of seizures to fully re-adapt to a seizure-free life if the epilepsy surgery is successful. The person may never have had an opportunity to develop independence, and he or she may have had school and work difficulties that could have been avoided with earlier treatment. Surgery should always be performed with support from rehabilitation specialists and counselors who can help the person deal with the many psychological, social, and employment issues he or she may face.
Even when surgery completely ends a person's seizures, it is important to continue taking seizure medication for some time to give the brain time to re-adapt. Doctors generally recommend epilepsy medication for two years after a successful operation to avoid new seizures.