Sometimes epilepsy is caused by a specific structural problem in part or parts of the brain. This may have resulted from some form of head injury, occurring either at birth or in later life, or from an infection in the brain. It is also possible that the brain did not develop properly or there is some form of scarring, lesion or birthmark on the brain, which the person was born with. Some of these people may benefit from having epilepsy surgery

Considerations for epilepsy surgery:
Among the considerations for an epilepsy surgery are seizure frequency, seizure type, severity of attacks, and impact on quality of life. Before seizures are deemed intractable it is necessary to be certain that the correct drugs have been used in the correct amounts.
Complex partial seizures are more likely to be intractable than tonic-clonic or other common forms of epilepsy. In uncontrolled complex partial seizures, the frequency of seizures varies from less than one a week to five or more each day.
The clinical manifestations also vary in different patients. Some are not apparent to anyone but the patient; others disrupt daily activities and are socially embarrassing. If a patient falls during seizures that occur only a few times a year, repeated injuries and trips to emergency rooms can make life miserable. Even one seizure a year may disqualify a person from having a driver's license.
Disability is also influenced by the reaction of the patient's family, friends, teachers, or employers. All of these factors have an impact on what is judged severe enough to warrant consideration of surgical therapy.

Epilepsy surgery and its implications:

1. Positive implications:
There are other reasons to consider surgical therapy. For instance, repeated seizures may have adverse effects on the brain, leading to progressive cerebral degeneration and more severe clinical handicaps. Chronic use of antiepileptic drugs may cause toxic syndromes and may also have adverse effects on learning, scholastic achievement, development, and job performance.
2. Negative implications:
On the other hand, surgery has risks and costs that have to be considered. Before a patient is accepted for surgery, it is necessary to be certain of the diagnosis and the adequacy of previous drug therapy.
Evaluation for surgery includes several methods: video- monitoring, brain imaging, different kinds of electroencephalography, and neuropsychological tests. The best combination of these studies has yet to be defined. Investigators do not agree about the preoperative need to identify areas of the brain that control speech.