Specialist neurosurgery · UK
Epilepsy surgery in the UK, a patient guide.
Drug-resistant epilepsy has more options than most people realise — resective, disconnective, ablative and neuromodulation. This is what the UK pathway actually looks like, from work-up to driving again.
Why patients choose us
- 01
A commissioned centre, not a private hunch
Epilepsy surgery in the UK is centrally commissioned by NHS England — adult work sits in 10 specialist neurosurgery centres, paediatric work in 5. We help you get to the right one.
- 02
The full pre-surgical work-up on the table
Video-EEG telemetry, 3T MRI epilepsy protocol, PET, SPECT, MEG, neuropsychology and psychiatry — presented to a proper MDT before anyone opens a skull.
- 03
Every option, not just the one on offer
Resective, disconnective, ablative (LITT), or neuromodulation (VNS, DBS, RNS). We help you understand which fits your seizures and your life.
Indicative pricing
What each step of epilepsy surgery costs privately in the UK.
Epilepsy surgery is centrally commissioned by NHS England and free at the point of care. Private ranges below are shown for the small number of patients who pursue elements privately.
In short
Adult epilepsy surgery is commissioned across 10 NHS England centres and paediatric across 5.
| Step | Indicative private range | Typical duration | Recovery / admission |
|---|---|---|---|
| Neurologist consultation (drug-resistant epilepsy) | £300–£500 | 45–60 min | Same visit |
| Video-EEG telemetry (inpatient, 3–7 days) | £6,000–£15,000 | 3–7 days | 2–4 weeks |
| 3T MRI — epilepsy protocol | £800–£1,400 | 45–60 min | 3–5 days |
| FDG-PET / ictal SPECT / MEG | £1,500–£4,000 | Half-day | 1–2 weeks |
| Stereo-EEG (SEEG) invasive monitoring | £25,000–£45,000 | 5–10 days | Inpatient |
| Anterior temporal lobectomy + amygdalohippocampectomy | £30,000–£55,000 | 4–6 h GA | 7–10 day admission |
| Laser interstitial thermal therapy (LITT) | £35,000–£60,000 | 3–5 h GA | 2–3 day admission |
| Vagus nerve stimulator (VNS) implant | £20,000–£30,000 | 1–2 h GA | Day case / 1 night |
| Deep brain stimulation (DBS — ANT thalamus) | £45,000–£75,000 | 5–7 h GA | 3–5 day admission |
Ranges vary by centre, by the surgeon, by which imaging and invasive monitoring are needed, and by the specific procedure. For most patients the whole pathway sits inside an NHS-commissioned service and no private fee applies.
The problem
Around 30% of people with epilepsy don’t respond to medication. Many never get assessed.
NICE NG217 says surgical assessment should be offered once two AEDs have failed. In practice, referral is often delayed by years. We help you get to a commissioned Level 4 centre while the decision still matters.
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Not sure surgery is on the table?
If two properly tried AEDs have failed, NICE NG217 says you should be referred for surgical assessment — even if surgery is not eventually the answer.
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Worried it means brain surgery?
Not always. LITT, VNS and DBS avoid open resection. The MDT chooses the least invasive option that fits your seizures.
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Want the full pre-surgical work-up?
Video-EEG telemetry, 3T MRI, PET/SPECT/MEG, neuropsychology and psychiatry — all together at a commissioned centre.
The pathway
From drug-resistance to driving — what happens, in order.
The UK epilepsy surgery pathway usually takes months, sometimes over a year, because the work-up matters more than the operation.
Phase 1 · Before surgery
Referral, work-up and MDT
Phase 2 · The operation
GA, theatre and ICU
Phase 3 · After
Recovery, AEDs, driving
- 01
Before
Confirming drug-resistant epilepsy
Failed at least two tolerated, appropriately-dosed AEDs — around 30% of people with epilepsy. This is the NICE NG217 threshold for Level 4 specialist assessment.
- 02
Before
Referral into a commissioned centre
NHS England commissions adult epilepsy surgery at 10 centres and paediatric at 5. Referral is via a neurologist to a Level 4 epilepsy service.
- 03
Before
The pre-surgical work-up
Video-EEG telemetry, 3T MRI epilepsy protocol, PET or SPECT for localisation, MEG where indicated, neuropsychology, psychiatry, and functional MRI (or Wada) for language and memory.
- 04
Before
Invasive monitoring, if needed
When scalp EEG cannot localise the focus, invasive monitoring is offered — increasingly stereo-EEG (SEEG) first in the UK, occasionally subdural grids.
- 05
Operation
MDT decision and consent
The multidisciplinary team agrees a plan — resective, disconnective, ablative or neuromodulation — and consents you with expected seizure outcome and specific risks.
- 06
Operation
Surgery under GA
Three to eight hours under general anaesthetic depending on procedure. ICU for 24–48 hours after craniotomy, then a step-down ward.
- 07
After
Recovery, AEDs and driving
5–14 day admission, 6–12 week recovery. AEDs are typically continued for at least two years then a trial wean considered. DVLA seizure-free driving rules are explained on discharge.
Typical end-to-end: 6–18 months from referral to surgery. Full recovery: 6–12 weeks.
When it helps
The epilepsies where surgery is worth considering.
The situations we see most, plus the one red flag that means an ambulance rather than an appointment.
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Drug-resistant focal epilepsy
Seizures still happening after two properly tried AEDs — the point where surgical assessment is recommended by NICE NG217.
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Mesial temporal sclerosis
Scarring of the hippocampus on 3T MRI — the classic indication for anterior temporal lobectomy, with 60–80% seizure freedom at one year.
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Focal cortical dysplasia
A malformation of cortical development — often subtle on MRI but a good target for tailored resection or LITT.
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Cavernoma or low-grade tumour
A cavernous malformation or DNET/ganglioglioma causing seizures — lesionectomy is often curative.
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Hemispheric syndromes
Rasmussen encephalitis, hemimegalencephaly or Sturge–Weber — hemispherotomy can transform daily life in a severely affected hemisphere.
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Lennox–Gastaut with drop attacks
Corpus callosotomy is offered to reduce injurious drop attacks when resection is not possible.
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Generalised or multifocal epilepsy
When resection is not an option, vagus nerve stimulation or deep brain stimulation of the anterior nucleus of the thalamus may be considered.
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Red flag: status epilepticus
A seizure lasting more than five minutes, or repeated seizures without recovery, is a medical emergency — 999, not a clinic booking.
Surgical options
Resect, disconnect, ablate or modulate.
Epilepsy surgery is not one operation but a family of them. This is what each option actually involves and which problem it fits.
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Anterior temporal lobectomy
The workhorse of epilepsy surgery. Removes the anterior temporal lobe and amygdalohippocampal complex for mesial temporal sclerosis — 60–80% seizure-free at one year.
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Lesionectomy
Focused removal of a discrete lesion — cavernoma, DNET, ganglioglioma, focal cortical dysplasia — often with excellent seizure outcomes.
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Tailored neocortical resection
Custom resection of an epileptogenic zone outside the temporal lobe, guided by SEEG and functional mapping to spare eloquent cortex.
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Hemispherotomy
Functional disconnection of an entire hemisphere for Rasmussen, hemimegalencephaly or Sturge–Weber — offered when one hemisphere is already severely damaged.
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Corpus callosotomy
Disconnective surgery that divides the corpus callosum to reduce drop attacks in Lennox–Gastaut and other generalised epilepsies.
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Laser interstitial thermal therapy
MRI-guided laser ablation of a small deep focus through a stab incision — lower morbidity than open surgery, gaining ground in the UK.
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Vagus nerve stimulation (VNS)
A pacemaker-like device on the left vagus. NICE-approved — around 50% of people get 50% seizure reduction over time. Not a cure, but often a meaningful lift.
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Deep brain stimulation (ANT)
DBS of the anterior nucleus of the thalamus. NICE-approved in 2020 on the strength of the SANTE trial — for drug-resistant focal epilepsy not suitable for resection.
The commissioned UK network
A small number of centres, chosen by NHS England.
Adult epilepsy surgery is delivered at 10 NHS England-commissioned neurosurgery centres and paediatric work at 5. We help make sure your referral lands in the right one.
Selection criteria
What makes a centre right for epilepsy surgery.
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A commissioned NHS England Level 4 adult (10) or paediatric (5) epilepsy surgery centre
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Full pre-surgical work-up on site — video-EEG telemetry, 3T epilepsy MRI, PET, SPECT and MEG where indicated
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Stereo-EEG (SEEG) capability with an experienced functional neurosurgery team
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Neuropsychology, psychiatry, epilepsy nurse specialists and MDT integrated into every decision
Safety and recovery
The risks that matter — honestly, by procedure.
Epilepsy surgery is one of the best-studied areas of neurosurgery. The risks are real but they are known, and they are quoted by procedure — not in the abstract.
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A long, careful work-up before any operation
Video-EEG telemetry, MRI, PET/SPECT/MEG, neuropsychology and psychiatry take months. The point is to be sure surgery will help before offering it.
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General anaesthetic, ICU and a proper admission
Most procedures take 3–8 hours under GA, with 24–48 hours in ICU after craniotomy and a 5–14 day admission overall.
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Temporal lobectomy — visual field and memory
A superior quadrantanopia (a quarter of the upper visual field) is expected in 30–50% and often unnoticed. Verbal memory can decline if the dominant hemisphere is operated on.
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Hemispherotomy — expected deficits
A predictable hemiparesis and hemianopia — usually pre-existing from the underlying condition rather than caused by surgery.
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LITT — lower morbidity, different trade-offs
A stab incision and MRI-guided ablation avoids a craniotomy. Seizure freedom rates are lower than open surgery for some indications but recovery is much quicker.
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VNS — voice change, cough, infection
A hoarse voice or cough when the device fires is common. Device infection or lead problems occur in a small minority.
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DBS — hardware, mood and cognition
Small risks of infection, haemorrhage and hardware failure, plus mood or cognitive changes that are usually manageable with stimulation adjustment.
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AEDs continue after surgery
Anti-epileptic drugs are typically continued for at least two years post-operatively, then a trial wean is considered if you remain seizure-free.
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DVLA and driving
Driving requires a seizure-free period defined by the DVLA — usually 12 months for Group 1 licences, longer for Group 2. Your team explains the rules on discharge.
Reading your operation note
Your MDT and operation notes in four parts. Read the last one first.
Whichever procedure was chosen, the notes the epilepsy team sends you tend to keep to the same shape.
A quiet reminder
Epilepsy notes are dense and technical — we translate them for you.
If you would like us to talk you through the MDT letter or operation note before your review, just ask.
- 01 Header
Diagnosis, seizure semiology and AED history
The epilepsy syndrome, which AEDs have been tried at what dose, and why drug-resistance has been confirmed under NICE NG217.
- 02 Localisation
MRI, EEG, PET/SPECT/MEG and SEEG findings
Where the seizure focus is thought to sit, what each modality contributed, and how well the data converge.
- 03 Procedure
The operation performed and any complications
The exact procedure — resection, disconnection, LITT or device — anaesthetic time, blood loss, ICU stay and any intra-operative events.
- 04 Plan
Expected outcome, AED plan, review and driving
Read this first: expected seizure outcome, when the AED wean might be considered, the follow-up plan and the DVLA driving rules that now apply to you.
Recognised by major UK insurers
Epilepsy surgery in the UK is almost always delivered inside the NHS England-commissioned service. Private insurance rarely covers it end-to-end — we confirm what your policy will and will not fund before anything is booked.
Frequently asked
Everything patients ask us about epilepsy surgery.
Quick answers on candidacy, the pre-surgical work-up, outcomes, recovery and driving.
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Who is a candidate for epilepsy surgery in the UK?
People with drug-resistant epilepsy — defined by NICE NG217 as failure of at least two tolerated, appropriately-chosen and appropriately-dosed AEDs. That is around 30% of people with epilepsy. Assessment is via a Level 4 epilepsy service in an NHS England-commissioned centre.
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How is epilepsy surgery commissioned in the UK?
Adult and paediatric epilepsy surgery are centrally commissioned by NHS England specialised neurosurgery services — 10 adult centres and 5 paediatric centres across the country. All cases go through a specialist MDT before any operation is offered.
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What is involved in the pre-surgical work-up?
Video-EEG telemetry to capture seizures, a 3T MRI on an epilepsy protocol, FDG-PET, ictal SPECT and MEG for localisation where needed, and neuropsychology and psychiatry assessment. Functional MRI or a Wada test may be used to map language and memory. When scalp EEG cannot localise the focus, invasive monitoring — increasingly stereo-EEG (SEEG) in the UK — is offered.
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What is anterior temporal lobectomy and how well does it work?
Anterior temporal lobectomy with amygdalohippocampectomy is the classic operation for mesial temporal sclerosis. Around 60–80% of well-selected patients are seizure-free at one year, with long-term rates a little lower.
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What are LITT, VNS and DBS?
LITT is MRI-guided laser interstitial thermal therapy — an ablation via a stab incision. VNS is a pacemaker-like vagus nerve stimulator, NICE-approved, with around half of patients getting a 50% reduction in seizures. DBS of the anterior nucleus of the thalamus is NICE-approved (2020) for drug-resistant focal epilepsy not suitable for resection, based on the SANTE trial.
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What are the main risks of temporal lobectomy?
A superior quadrantanopia (a quarter of the upper visual field) is expected in 30–50% and is often unnoticed. Verbal memory can decline if the dominant hemisphere is operated on. Hemiparesis is uncommon (under 5%), and mood change is possible. All risks are discussed in detail before consent.
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How long is the recovery from epilepsy surgery?
Most people spend 5–14 days in hospital, with 24–48 hours in ICU after craniotomy. Full recovery takes 6–12 weeks. LITT and VNS have shorter admissions. AEDs are typically continued for at least two years, then a trial wean is considered if you remain seizure-free.
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When can I drive again after epilepsy surgery?
Driving is governed by DVLA seizure-free rules — usually 12 months seizure-free for a Group 1 licence and longer for Group 2. The exact rules depend on your seizure history and any medication changes, and your team will explain them on discharge.
Related
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