Currently, there are many patients who know that epilepsy can be operated on, but are unsure how effective epilepsy surgery is. Can it be completely cured? The following are some of the most frequently asked questions about surgery for epilepsy: 1. How many patients with epilepsy can be considered for surgery? This is actually a more complex and difficult question to decide. In general, the majority of patients (80%) do not need surgery and can be effectively controlled by regular medication (including those who do not have seizures and those who still have a few seizures), and the other 20% are called “drug-refractory epilepsy”, meaning that after at least 2 years of ineffective regular medication, patients still have frequent seizures. The other 20% we call “medically refractory epilepsy”, meaning that after at least 2 years of regular medication, the patient still has frequent seizures. The meaning of “frequent seizures” here is also changing. In the past, due to the low experience in surgical treatment and the high risk, it generally meant more than 4 seizures per month. The meaning of “frequent seizures” generally refers to more than 1 seizure per month or to more than 10 seizures per year, although this is not absolute. Some types of epilepsy with clear foci, although the number of seizures is very small, but it is expected that the future is unlikely to be completely controlled by drugs, and the expected effect of surgery is very good, can also be operated as early as possible (in fact, it is often encountered that even if there are only 1 – 2 seizures per year, the patient still strongly requests -This is based on the impact of the seizures on the patient, as well as the risk and efficacy of surgery). The 20% of patients with drug-refractory epilepsy have the need for surgery, but only half of them can be operated after the final evaluation, which means that only about 10% of all epilepsy patients can be operated. As you can see from the above, the number of seizures is of great concern to physicians. However, often patients refer to seizures as “falls and generalized convulsions”, but very mild seizures should be included, such as a brief froth, sudden stopping of movement, dropping an object, or a premonition of a seizure, even if it is only for a second or a few seconds. In fact, this minor seizure manifestation is more important (especially for the determination of the origin of the seizure). In addition, the number of seizures is often irregular, which also requires summary and generalization by the patient and family members, such as when there are few seizures, how long can there be no seizures between seizures, and how many seizures per day (or per week or month) in severe cases. There are several types of seizures and the number of seizures of each type. 2. What is the cost of epilepsy surgery? This is also a question that is often encountered and not easy to answer. Epilepsy is actually a form of clinical manifestation of many diseases (mainly brain diseases). In general, seizures can occur when the brain tissue is injured or not developed properly, and the diagnosis and treatment options vary greatly for different causes. In some cases, the cause of the disease can only be determined after surgery (by removing the brain tissue). For some patients with a clear “epileptogenic focus”, the patient is in good condition, the surgery is relatively simple, and the treatment process is smooth, the total cost can be less than 30,000 yuan. In general, if the post-operative recovery is smooth, the total cost will be about 70-100,000 RMB, and it is common to see more than 100,000 RMB, but it is rare to see more than 130,000 or 150,000 RMB. 3.Common cases that can be operated. Theoretically, an operable case is one in which the doctor determines that there is a relatively limited “epileptogenic focus” in the brain and can accurately locate it, and also determines that removing this part of the brain tissue will not cause serious functional damage (or even if there is some damage, the patient’s overall quality of life is still improved). However, due to the limitations of medical technology and the complexity of brain function, individual differences, etc., it is not possible to be 100% sure before surgery, which means that there is a possibility that the brain function will be damaged and the seizures will not be controlled, or even worsen. In my experience, surgical results are better in the following cases: (1) There is a limited lesion in the brain on MRI, and the patient’s seizure performance and EEG confirm that the “epileptogenic focus” is in the lesion area. The patient’s seizure manifestations are commonly hazy consciousness, smacking, chewing, swallowing, groping, and in severe cases, generalized convulsions. Some patients also have premonitory sensations, such as rising stomach gas, fear, déjà vu, etc. The surgical outcome of such patients is excellent. There are many other types (e.g., cerebral softening foci, localized brain dysplasia, etc.), and the location of the lesion varies, so does the patient’s seizure presentation. However, the “epileptogenic focus” often includes not only the lesion area but also the surrounding seemingly normal brain tissue, which requires more comprehensive localization and functional localization. This is a common cause of surgical failure for less experienced surgeons in the past. (2) Some patients have a normal MRI despite the presence of an “epileptogenic focus”. Some of them can be clearly described, such as seeing something abnormal in front of the eyes, or hearing a sound that others cannot hear, or feeling abnormal (numbness in a certain area, or not feeling the presence of a limb, etc.), or they can be non-specific or indescribable, such as out-of-body feeling, seeing an alter ego, weightlessness like riding an elevator or roller coaster, confusion in the brain, etc. confusion, etc. These premonitions are very important and can be used by the physician to determine the likely site of origin of the seizure and then to perform a targeted examination. There are also patients who do not have premonitions, but the seizure process is gradually expanding (which also reflects a diffusion process of abnormal EEG discharges), or the patient’s mind is clear at the time of the seizure, which means there is no loss of consciousness, which also indicates that the seizure is limited to a certain area of the brain. All these characteristics can be examined step by step to clear the fog and find out the real culprit. 4. Common situations that are not suitable for surgery. (1) There are many types of seizures, less than one-third of which we call “generalized seizures”, which are inoperable because current research shows that the mechanism of these types of seizures is unknown, at least not from one part of the brain, so there is no way to operate. There are certainly a few physicians who have made some attempts and have yet to see valid conclusions, and blind, subjective, one-sided surgical options are very dangerous! Of course, accurate diagnosis is very important. I often encounter people who treat “partial seizures” as “full-blown seizures”, and those who diagnose “full-blown seizures” as “partial seizures”. “(2) Some patients have seizures and have surgery, with serious consequences. (2) Some patients have multiple forms of seizures, frequent seizures (even multiple times per day), poor intellectual level, and ineffective multiple medications, while MRI shows no significant structural abnormalities in the brain, or MRI results show widespread abnormalities in the brain, which often suggest that surgery is unlikely. Because these characteristics often suggest extensive brain damage or multiple abnormalities, I have tried to do a few patients (serious condition, and there is really no reliable method), the vast majority of surgery is ineffective, and some are worse after surgery, very few patients have improved, I think it is also difficult for other cases to refer to, so I suggest it is better not to do surgery.