Updates on Surgery for Epilepsy

Medications control seizures most of the time in people with epilepsy. However, others may still have seizures despite trying multiple medications.

At this point, these individuals are very unlikely to become seizure-free with future medications. Epilepsy surgery should be considered then as it is more likely to lead to improvement.

New technology has made epilepsy surgery very safe. In this Clinicians Corner learn about updates on surgery methods for epilepsy.

Radiofrequency Ablation and Stereo-electroencephalography in Epilepsy 

Radiofrequency ablation (RFA) is a surgical technique developed almost one hundred years ago. Radiofrequency (RF) energy is used to heat up and remove abnormal tissue. RF energy is made up of radio waves, which is safe and does not cause radiation damage.

Stereo-electroencephalography (SEEG) is a surgical technique developed in Europe in the 1950s. Electrodes are placed into the brain to discover where a seizure starts within the brain. Where the seizure starts is “mapped” and then later safely removed. The goal for this surgery is seizure freedom.

Combining SEEG and RFA

These two techniques are now often being combined in the United States in patients with epilepsy.  

To do this, neurologists and neurosurgeons make the SEEG plan. Then the neurosurgeon places the electrodes. Together, the team maps where the seizure starts. If the seizure appears to start in a small area, RF energy is used to heat up the electrodes. This removes the tissue that appears to be causing seizures. The RF system allows the surgical epilepsy team to monitor and control temperature in real time as they heat up the electrodes.  

While this is new in the United States, SEEG and RFA has been used for decades in Europe with good success. RFA can give useful information, but the amount of tissue removed is very small. Patients can become seizure-free for a short time, but will usually need a final surgery to become seizure-free for longer. People who do not become seizure-free after RFA may not respond well to future surgery. 

Updates on Neuromodulation/Neurostimulation 

Removing tissue that causes seizures is always the first surgical treatment option when possible. This can be path towards seizure freedom.  They often are able to reduce or stop medications and quality of life can improve greatly.   

Sometimes, however, removing tissue that causes seizures is not possible. Seizures can come from a brain area that cannot be removed because that area of the brain is controlling important functions; or they may start in many different areas of the brain. They may start all of a sudden throughout almost the entire brain. If this happens, individuals with epilepsy can benefit from nerve or brain stimulation.

Luckily, today, almost every person with epilepsy can benefit from some type of stimulation option.

Current Stimulation Options

Options at this time include vagus nerve stimulation (VNS), responsive neuronal stimulation (RNS) and deep brain stimulation (DBS).

Which stimulation option to choose depends on each individual person.  This decision is made with the person and their epilepsy team. It depends on the person’s kind of epilepsy, what their seizures look like on EEG and many other factors.  

Responsive Neurostimulation (RNS)

For some people with epilepsy, the brain area causing seizures is known, but cannot be removed. These patients can undergo RNS in which electrodes are placed in the brain area causing seizures. These electrodes can detect when a seizure starts. When a seizure starts, the device stimulates the region to try and stop the seizure. Individuals who have RNS devices typically improve the number of seizures by about 80% over many years and improve their quality of life.

Deep Brain Stimulation (DBS)

In some people with epilepsy, we do not know the exact area where seizures are starting. These people often undergo DBS. With DBS, electrodes are placed into a specific area of the brain. This area should be related to the person’s specific epilepsy. After stimulation is turned on, DBS typically improved seizures by about 75% over many years and improve their quality of life.

Emerging Options for Generalized Epilepsy

People with generalized epilepsy will soon have a new brain stimulation option. 

These are people who have seizures that start throughout the brain or move very quickly throughout the entire brain.

There is a current clinical trial of brain stimulation in patients with idiopathic generalized epilepsy (IGE). This showed that stimulation of the centromedian nucleus (CM) of the thalamus has reduced seizure frequency by 77% compared to their baseline. These findings will likely lead to FDA approval of CM stimulation for IGE in the near future.  

Personalized stimulation 

Many epilepsy centers that perform epilepsy surgery are performing customized surgeries. This is where different regions of the brain are stimulated at the same time.

This depends on the type of epilepsy the patient experiences. Many centers are also now customizing the type of stimulation a patient receives. This is based on the person’s own brain recordings. New surgical devices can actually record from the area of the brain that the electrode is implanted. This gives neurologists, neurosurgeons and engineers information that can be used to customize stimulation patterns. Meaning, the stimulation is customized to the individual person. 

Learn More

If you or someone you know has epilepsy that cannot be controlled with medications, reach out to EFMN and they can refer you to your local Level 4 Epilepsy Center.  

Author:

Robert McGovern, MD
University of Minnesota Physicians, St. Louis Park MINCEP Epilepsy Care

References 

1. Kwan P and Brodie MJ. Early identification of refractory epilepsy NEJM 2000 342(5):314-9. 

2. Bancaud J., Talairach J., Bonis A., Schaub C., Szikla G., Morel P., Bordas-Ferer M.: La stéréoencéphalographie dans l’épilepsie . 1965 . Masson et Cie Paris , pp. 313. 

3. Guenot M, et al. SEEG-guided RF thermocoagulation of epileptic foci: feasibility, safety, and preliminary results. Epilepsia 2004. 45(11):1368-74. 

4. Salanova V, Sperling MR, Gross RE, et al. The SANTÉ study at 10 years of follow-up: Effectiveness, safety, and sudden unexpected death in epilepsy. Epilepsia. 2021;62:1306-1317. doi: 10.1111/epi.16895.  

5. Eliashiv D, Jobst B, Morrel M. Multicenter Post-approval Study of the RNS System in Focal Epilepsy (S20.009). 2025. 104(7_Supplement_1) 5244. https://doi.org/10.1212/WNL.0000000000212230 

6. Morrel M, et al. Safety and one year effectiveness of responsive thalamic stimulation for treatment of IGE and GTCs. Presented at the 2025 American Epilepsy Society meeting. Dec 7 2025. Abstract no. 2.439. Accessible at: https://aesnet.org/abstractslisting/safety-and-one-year-effectiveness-of-responsive-thalamic-stimulation-for-treatment-of-ige-and-gtcs