Why does surgery fail to cure limbic epilepsy? Seizure functional anatomy may hold the answer

Surgery for the mesial temporal lobe epilepsy syndrome is highly effective in controlling seizures in as many as 80% of the patients who undergo this procedure. However, the majority of the patients with successful operations still require medications to control their seizures. Only a small minority are able to stop medications and remain seizure free, patients who would be considered cured. Why are so few patients cured by this procedure? The answer may lie in the relation of the critical seizure circuits to the tissue that is actually resected. In this paper we will discuss two hypotheses for the functional anatomy of limbic epilepsy in light of what is known about the pathology and physiology of limbic epilepsy. Combining the clinical and scientific observations with these constructs for seizure initiation may lead us to a better understanding of this particular epilepsy syndrome as well as to more effective surgical approaches.