Epilepsy surgery offers the chance of seizure remission for the 30%–40% of patients with focal epilepsy whose seizures continue despite anti-epileptic medications. Epilepsy surgery encompasses curative resective procedures, palliative techniques such as corpus callosotomy and implantation of stimulation devices. Pre-surgical evaluation aims to identify the epileptogenic zone and to prevent post-operative neurological and cognitive deficits. This entails optimal imaging, prolonged video-electroencephalogram (EEG) recordings, and neuropsychological and psychiatric assessments; some patients may then require nuclear medicine imaging and intracranial EEG recording. The best outcomes are in those with an electro-clinically concordant structural lesion on MRI (60%–70% seizure freedom). Lower rates of seizure freedom are expected in people with extra-temporal lobe foci, focal-to-bilateral tonic-clonic seizures, normal structural imaging, psychiatric co-morbidity and learning disability. Nevertheless, surgery for epilepsy is under-used and should be considered for all patients with refractory focal epilepsy in whom two or three anti-epileptic medications have been ineffective.
- epilepsy surgery
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Contributors FR-G drafted and revised the manuscript. AME and AM provided figures and revised the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests FR-G has received a speaker's honorarium from LivaNova. AME has received honoraria from Baxter, UCB and Integra, sponsorship to attend meetings from Leksell, Medtronic, Brainlab, Modus V and hospitality from Livanova. AM has received sponsorship to attend meetings from Medtronic and Modus V and received hospitality from Livanova. Research funding via Wellcome has Medtronic named as the preferred commercial partner.
Patient consent for publication Not required.
Provenance and peer review Commissioned. Externally peer reviewed by Khalid Hamandi, Cardiff, UK.