Surgical treatment of epilepsies

Epilepsy is characterized by recurrent epileptic seizures. Surgical interventions represent a reasonable alternative to long-term antiepileptic drug treatment in those patients destined to achieve incomplete seizure control. The presurgical work-up aims at identifying appropriate surgical candidates. Surgical options with a curative goal include temporal and extratemporal resections and hemispherectomy. With these procedures complete seizure control can be achieved in approximately 2/3 of patients. With palliative procedures such as callosotomy, multiple subpial transections, and vagal nerve stimulation, approximately half of the patients will significantly improve after surgery. In all, epilepsy surgery has proven to be a highly effective treatment option. Major problems include the definition of the epileptogenic area with respect to optimal seizure control and minimum neurological and neuropsychological impairment after surgery.