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Epilepsy surgery
  1. Fergus Rugg-Gunn,
  2. Anna Miserocchi,
  3. Andrew McEvoy
  1. Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
  1. Correspondence to Dr Fergus Rugg-Gunn, Dept of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London WC1N 3BG, UK; f.rugg-gunn{at}ucl.ac.uk

Abstract

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
  • epilepsy surgery
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Footnotes

  • 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.

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