Epilepsy surgery effective treatment for drug-resistant patients: Dr Fowzia Siddiqui

Successful surgeries in Pakistan highlight early intervention and multidisciplinary care for drug-resistant epilepsy

Epilepsy surgery is an effective treatment for patients with drug-resistant epilepsy, said Dr Fowzia Siddiqui, President of the Epilepsy Foundation Pakistan and neurologist/epileptologist at Aga Khan University Hospital in Karachi.

Dr Siddiqui made the remarks while addressing the scientific programme of the first international Pinscon 2025 Conference, where she presented her paper titled “Epilepsy Surgery: Patient and Procedure Selection and Outcomes.”

She explained that epilepsy surgery is particularly effective for patients with drug-resistant focal epilepsy who fail to respond to at least two appropriate anti-seizure medications. The goal of surgery is to remove or modify the brain region where seizures originate, while preserving essential neurological function.

“Careful patient selection through a multidisciplinary team—including epileptologists, neurosurgeons, and neuropsychologists—is crucial,” Dr Siddiqui said. She noted that ideal candidates have focal, localisable seizures arising from non-eloquent cortex and realistic expectations regarding surgical risks and benefits.

A comprehensive presurgical evaluation typically includes prolonged video-EEG monitoring, high-resolution MRI, and functional imaging such as PET, SPECT, or fMRI. Invasive monitoring with stereo-EEG or subdural electrodes is used when non-invasive methods are inconclusive.

Dr Siddiqui outlined that resective procedures—such as anterior temporal lobectomy, lesionectomy, or extratemporal resections—offer the highest chance of seizure freedom. Disconnection procedures (corpus callosotomy, subpial transection) and neuromodulation techniques (VNS, RNS, LITT) serve as palliative, adjunctive, or minimally invasive options for patients whose seizures are not resectable.

“Outcomes depend on epilepsy type, lesion localisation, and surgical completeness,” she added. Temporal lobe resections yield seizure freedom in up to 70–80% of suitable patients, while extra-temporal procedures achieve lower rates. Early evaluation and intervention, she said, improve seizure control, cognitive outcomes, and overall quality of life.

Dr Siddiqui highlighted that while medication remains the first-line treatment for epilepsy, surgical intervention has proven highly successful. “By the grace of Allah, many successful epilepsy surgeries have already been conducted in Pakistan,” she said, adding that she hopes to expand surgical treatment beyond Karachi through a new training program.