[The surgery of epilepsy]

At the present time the surgery of epilepsy is a safe, effective therapeutic option which should be offered to the patient with drug resistant epilepsy at the right moment to prevent the irreversible negative consequences of uncontrolled seizures.

All patients with drug resistant epilepsy should be surgically assessed. In recent years the concept of surgically remediable syndrome has been introduced to refer to conditions in which surgical treatment gives excellent results: mesial temporal sclerosis, circumscribed neocortical lesions, Sturge Weber syndrome and infantile hemiplegic epilepsy are good examples in which prolonged, unnecessary delay of surgery should not occur. This type of surgery should be undertaken in centres with suitable trained multi disciplinary teams with adequate resources and preestablished guidelines. The clinical history, surface electroencephalogram monitoring, directed magnetic resonance, functional neuroimaging with SPECT and PET and neuropsychological studies are the basis for pre surgical diagnosis. These and other investigations should be done following the guidelines of each centre and the complexity of the disorder in each case.

Anteromesial resection of the temporal lobe, selective amigdalo hippocampectomy, neocortical resection, hemispherectomy or a variation of it, section of the corpus callosum and multiple sub pial transection are the most usual surgical techniques since good results are obtained with them in suitable cases.