June 26, 2026
Major advances in the treatment of medication-refractory epilepsy offer new options for patients. Jonathon J. Parker, M.D., Ph.D., a neurosurgeon at Mayo Clinic in Phoenix/Scottsdale, Arizona, answers frequently asked questions about referring patients for innovative care.
The National Association of Epilepsy Centers rates Mayo Clinic's campuses in Arizona, and in Jacksonville, Florida, and Rochester, Minnesota, as Level 4 epilepsy centers — providing the highest level of diagnosis and treatment options for people with epilepsy.
When should patients be referred to a Level 4 epilepsy center?
The general guideline has been that patients should be referred for surgical evaluation if their seizures continue after trials of two medications at the maximum appropriate doses. But this guideline was recently updated: Patients who haven't responded to a single antiepileptic medication and have MRI evidence of a defined seizure-generating lesion should also have surgical evaluation.
Patients don't need to have extensive imaging before coming to Mayo Clinic. We work with referring physicians to figure out what elements of a workup can be done before patients arrive and what can be done here.
Does surgical evaluation mean a patient will have surgery?
Referral doesn't necessarily mean a patient will have surgery. At Mayo Clinic, patients have thorough clinical exams and diagnostic monitoring. A subspecialized team of neurologists, neurosurgeons, neuroradiologists and ancillary staff then meet to discuss the findings and present treatment recommendations to the patient.
Some patients might be good candidates for safe surgical resection of a lesion, which could lead to seizure freedom and remove the need for medication. Other patients might benefit from laser ablation or a neurostimulation device. The global trend is that not everyone is having resection or ablation. Often, we're doing reversible, adjustable, titratable therapies like neurostimulation.
How invasive is diagnostic testing?
In years past, identifying the exact region in the brain where seizures start generally involved craniotomy and then the placement of grids and strip electrodes on the surface of the brain. Modern diagnosis uses stereoelectroencephalography (SEEG). This is a method where thin wires that measure about 0.8 millimeters in diameter are placed in the brain robotically, to record activity and locate seizure origin sites. The wires are removed after seizures are captured, and the data are analyzed.
What other advanced diagnostic testing is performed?
Mayo Clinic has highly sophisticated imaging technology. To find seizure-origin sites, our options include 7T MRI, positron emission tomography and single-photon emission computerized tomography (SPECT). Subtraction ictal SPECT coregistered to MRI (SISCOM) can provide even more-detailed results.
Magnetoencephalography (MEG) is a newer tool that helps target locations for SEEG electrode placement. Mayo Clinic's campus in Minnesota is one of the few centers in the United States that routinely offers MEG. The test results can be shared with Mayo Clinic neurologists at the campuses in Arizona and Florida for patients who receive care there.
Functional MRI can find the exact locations of eloquent tissue, to guide surgery if that occurs.
Patients experiencing cognitive issues might also see a neuropsychologist. The goal is to establish cognitive baselines and to understand how epilepsy — and epilepsy medications — might be affecting cognition and memory. Those concerns are front and center for many patients.
How have treatment options evolved?
It used to be that focal epilepsy was the only epilepsy we could surgically treat. That required precise localization and resection or laser ablation, which of course isn't feasible if seizures originate in eloquent tissue.
Neurostimulation devices such as responsive neurostimulation (RNS) and deep brain stimulation (DBS) have proved very helpful for eloquent-region epilepsy.
Recently, we've started using RNS and DBS to treat generalized epilepsy and regional multilobar epilepsy, where seizures are coming from a broad network. We can actually treat those epilepsies now with neurostimulation.
How have treatment outcomes changed?
In the past there was variable success in terms of seizure reduction, especially for patients whose seizures didn't originate in the temporal lobe and thus were harder to treat.
But over the last decade or so, innovative technology and approaches have led to much better outcomes in epilepsy surgery, both in terms of seizure reduction and seizure freedom.
How do Mayo Clinic specialists work with a patient's community neurologist?
The community neurologist's longitudinal experience — the details the neurologist has learned about this person — is very valuable when we evaluate the patient.
After surgery or other treatment, we engage closely with the community neurologist as needed for issues like weaning the patient off medication or managing any continued medication. We stay in touch because the community neurologist is an equal part of the team.
What new approaches for managing epilepsy might be available in the future?
Regenerative medicine offers some exciting possibilities. Our neurologists are participating in studies testing gene and stem cell therapies. The idea behind both studies is to help the brain function better and thus avoid resection or ablation.
Our researchers also are studying a method of long-term recording of brain activity, as an alternative to EEG. Long-term data could help not only with epilepsy diagnosis but also with seizure prediction.
How might innovative treatment affect quality of life?
Unlike many diseases, epilepsy is a series of acute, largely unpredictable events. Patients live with the constant fear of having a seizure that causes loss of control and could potentially be fatal.
Now that we have new tools, we're trying to be more proactive about reducing seizure burden. Mayo Clinic's leadership in this area reflects our commitment to improving patients' quality of life.
For more information
National Association of Epilepsy Centers.
Refer a patient to Mayo Clinic.