Alternative surgical procedures to help drug-resistant epilepsy - a review

The concepts of pathophysiology of epilepsy which underly the non-resective surgical treatment of epilepsy are reviewed. The available techniques, lesioning, disconnection and stimulation are described and reviewed critically. Stereotactic lesioning, popular in the 1950's has been largely abandoned but stereotactic radiosurgery emerges as a useful technique, especially in the treatment of mesial temporal sclerosis. Disconnection by callosotomy has fewer applications than previously and multiple subpial transection (MST) has limited applications. Stimulation is a technique with increasing usefulness. Vagus nerve stimulation(VNS) is an accepted method of treatment with low morbidity and mortality, which improves seizure control in at least 30% of patients, together with concomitant improvements in QOL and economic advantages. Stimulation of deep brain targets in the thalamus, subthalamus and mesial temporal structures is practical. There are indications that this improves seizure control in groups of patients previously un helped by surgery, and this methodology has enormous potential.