I am 26, male, with seizures. Will I need brain surgery?

Question

Hello doctor,

I am a 26-year-old man who has had three generalized tonic-clonic seizures over the past six months, with the most recent one lasting 5 minutes and requiring emergency room treatment. My electroencephalogram (EEG) shows generalized spike-wave activity, and magnetic resonance imaging (MRI) revealed a small area of cortical dysplasia in my left frontal lobe that may be the seizure focus. My prolactin was elevated at 95 ng/mL post-seizure, and genetic testing for epilepsy-related genes was negative.

I have also been experiencing brief episodes of confusion and déjà vu sensations that might be focal seizures. I am terrified of having another major seizure in public. Could this epilepsy be controlled with medication, or will I need brain surgery? Am I at risk for sudden unexpected death in epilepsy (SUDEP), cognitive decline, or depression from recurrent seizures?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your history of tonic-clonic seizures, déjà vu, and brief confusion suggests focal epilepsy (from cortical dysplasia) with secondary generalization. The generalized spike-wave pattern on the electroencephalogram (EEG) may reflect widespread involvement, but the magnetic resonance imaging (MRI) finding makes a focal onset highly likely.

I would suggest the following measures:

Anti-seizure medications (ASMs) such as Levetiracetam, Lamotrigine, or Valproate (depending on your individual profile). Many patients achieve good seizure control with the right drug or combination.

If seizures continue despite trying at least two appropriate medications at adequate doses, this is considered drug-resistant epilepsy. In that case, surgical evaluation may be recommended, either resection of the cortical dysplasia or minimally invasive options like laser ablation. Pre-surgical testing, such as video electroencephalogram (VEEG), positron emission tomography (PET), magnetoencephalography (MEG), and neuropsychological assessment, helps guide this decision.

Sudden unexpected death in epilepsy (SUDEP) risk is higher if seizures are frequent and uncontrolled, especially nocturnal generalized tonic-clonic seizures. Achieving complete seizure control is necessary with medication (or surgery if needed). Repeated uncontrolled seizures and certain anti-seizure medications can affect memory, attention, and mood.

Depression and anxiety are common in epilepsy, partly due to the condition itself and partly from psychosocial stress. Regular follow-up and mental health support help reduce this risk.

Cognitive and mood effects can be minimized by preventing recurrent seizures and monitoring for side effects. Many patients with focal cortical dysplasia achieve seizure freedom with medication. If seizures persist, surgery offers one of the highest chances of cure compared to other causes of epilepsy. With proper treatment and follow-up, most people lead independent and productive lives.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.