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Surgery Insight: surgical management of epilepsy

Nature Clinical Practice Neurology volume 3, pages 673–681 (2007)Cite this article

Abstract

Epilepsy surgery has been shown to be an effective treatment for patients with intractable epilepsy. The only randomized controlled trial conducted in this setting to date found a dramatic advantage for surgery over medical treatment in temporal lobe epilepsy. In carefully selected patients, epilepsy surgery can control seizures, improve quality of life and reduce costs of medical care. Advances in diagnostic techniques are likely to improve patient selection, facilitate localization of epileptic foci and functional areas, and enable better prediction of outcomes.

Key Points

  • Epilepsy surgery has an important role in the management of chronic epilepsy

  • Currently, intractable epilepsy is defined by failure to achieve seizure cessation and intolerance of treatment

  • Major criteria for intractable epilepsy are the failure of seizure control with three anticonvulsant drugs and the presence of hippocampal sclerosis or cortical dysgenesis

  • A randomized trial of temporal lobe surgery versus medical management showed a 58% seizure-free outcome rate for the surgical group, compared with 8% for the medical management group

  • New surgical strategies include electrical cortical stimulation on demand and continuous deep brain thalamic and temporal lobe stimulation

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Figure 1: Surgery for temporal lobe epilepsy.
Figure 2: Localization of an epileptic focus by ictal single-photon emission computed tomography (SPECT).
Figure 3: Epilepsy surgery in Rasmussen's encephalitis.

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Acknowledgements

The authors' work is partially supported by the FACES Foundation (Finding A Cure for Epilepsy and Seizures). Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. R Kuzniecky is Professor of Neurology at New York University, and O Devinsky is Professor of Neurology, Neurosurgery and Psychiatry at New York University and Director of the New York University Comprehensive Epilepsy Center, New York, NY, USA.,

    Ruben Kuzniecky & Orrin Devinsky

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Correspondence to Ruben Kuzniecky.

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Kuzniecky, R., Devinsky, O. Surgery Insight: surgical management of epilepsy. Nat Rev Neurol 3, 673–681 (2007). https://doi.org/10.1038/ncpneuro0663

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