The first thing a doctor has to establish when considering surgery as an option is to establish the patients suitability. During this type of surgery, the more tissue that is removed the higher the risk to the patient. Therefore, only those patients whose seizures consistently begin in one small area of the brain are suitable for surgery. Sadly, this means that for the many people with epilepsy whose condition cannot be traced to a specific area of damaged tissue, surgery is not currently an option. Another consideration is the nature of the person's epilepsy.
Surgery is always a risk so the benefits have to be significant.
For this reason, doctors tend to only recommend those patients whose epilepsy has a very negative impact on their lives. These tend to be people who still have regular seizures despite trying a variety of medication. The doctor will want to know that surgery will greatly improve seizure control. It is the quality of a person's life that will be a main factor in the decision. In some people, a relatively small number of seizures can have a dramatic impact on their lives while others can tolerate a much higher number of seizures without it significantly affecting their well being.