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Oxford University Hospitals NHS Foundation Trust
Epilepsy Surgery Service

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Things to consider

If you have a good understanding of the benefits and risks of surgery, and your expectations of the outcome are realistic, you are much more likely to be satisfied.

If the assessments show that epilepsy surgery is a possibility for you, it is important that you consider carefully whether or not to have surgery. The results of the investigations will provide information specific to you about the likely risks and benefits.

Your Consultant Neurologist and other members of the team will discuss this with you in detail, and you will have the opportunity to ask questions. The information in this section is not a substitute for these discussions but the following aspects are important to consider.

Medication

For many, a motivation for undergoing epilepsy surgery is to reduce medication or become medication-free. While for some people this may be possible in the long term, all people remain on their medication for at least the first year following surgery. We recommend that you speak to your neurologist for advice specific to you.

Driving

An additional motivation for undergoing surgery is often to gain or regain a driving licence. This can be the case if people become seizure-free after surgery. However, even if seizures are significantly reduced, one seizure a year would mean that gaining a driving licence would not be possible. Some people may also acquire a visual field impairment following surgery, so even if they become seizure-free they will not be able to drive.

Epilepsy and driving - www.gov.uk

Employment

After epilepsy surgery you will need time off work to recover (normally around three months). Discuss this with your employer and consider the financial implications.

Speak to your Epilepsy Specialist Nurse if you have any concerns about employment; they can refer you to our Occupational Health Practitioner if appropriate.

Memory

Memory difficulties are commonly associated with epilepsy, especially temporal lobe epilepsy, as the temporal lobes of the brain are very important for memory. Surgery for temporal lobe epilepsy usually involves removal of part of the left or right temporal lobe, so it is not unusual to experience increased memory difficulties after surgery (the neuropsychological assessment aims to investigate this risk and so this will be discussed with you). If you already have memory difficulties you may be less likely to notice a deterioration after surgery.

Whatever the cause of memory problems, using strategies is usually most helpful and we would strongly recommend putting these into practice before surgery so that it will be easier for you to cope after surgery.

Visit 'Prehabilitation' for more about recommended strategies.

Memory - www.epilepsysociety.org.uk

Language

The left temporal lobe (occasionally the right temporal lobe in left-handed people) is also important for aspects of language. People with epilepsy sometimes struggle to find a word that is 'on the tip of their tongue'. Increased difficulty with this aspect of language is also common in people with left-sided temporal lobe epilepsy.

Mood

It is not unusual to experience a dip in mood soon after surgery. You may be more likely to experience this if you have experienced mood-related difficulties (such as anxiety or depression) in the past.

Normally this will improve over a few weeks or months, but some people can experience ongoing mood-related difficulties and find it more difficult to adjust.

The following factors may increase your risk of mood disturbance:

  • low self-confidence
  • social isolation
  • not currently working because of epilepsy.

Life after surgery can involve changes to your self image and mood, as well as daily activities, family relationships and social opportunities. For some people a period of adjustment is necessary.

It is important to give yourself time to adjust. If your life has been significantly disrupted by seizures, this can take longer. We will review you regularly for at least five years and make suggestions.

Visit 'Prehabilitation' for more about recommended strategies.

Quality of life

The aim of epilepsy surgery is to improve quality of life. This is difficult to define, but the following definitions have been suggested.

  • "How an person measures the 'goodness' of multiple aspects of their life. These evaluations include one's emotional reactions to life occurrences, disposition, sense of life fulfilment and satisfaction, and satisfaction with work and personal relationships"
  • "The extent to which an person's life is comfortable or satisfying"
  • "The degree to which a person is able to function at a usual level of activity without, or with minimal, compromise of routine activities"

Researchers have found that quality of life depends more on the things we do every day and less on our circumstances. This means that becoming seizure-free in itself is not likely to result in long-lasting improvements in quality of life.

What you can do with seizure-freedom or reduction is more important. Think about changes you would make after surgery, but be realistic. Maybe think of surgery as the opportunity to start making changes.