Epilepsy surgery

Abstract

If the first two or three antiepileptic drugs used do not control epilepsy, there is little chance that subsequent medications will be effective. In individuals with refractory focal epilepsy, neurosurgery can have a 60–70% chance of bringing long-term remission and these cases should be referred to a specialised centre for evaluation. The standard evaluation includes clinical review, brain imaging with magnetic resonance imaging, recording of seizures with prolonged scalp electroencephalography (EEG) and video, neuropsychological and psychiatric assessments. The aim is to establish converging evidence that there is a single epileptic focus and that the rest of the brain is functioning normally. In some individuals further evaluation with functional imaging and intracranial EEG recordings may be necessary. The most commonly performed resective operation is an anterior temporal lobe resection to remove a sclerotic hippocampus, followed by lesionectomies and neocortical resections. Palliative manoeuvres, to reduce seizure frequency and severity include corpus callosotomy, subpial transection and vagal nerve stimulation.