[Surgical treatment of epilepsy: another therapeutic option]

Around 10,000 patients with pharmacoresistant epilepsy are living in Switzerland for whom surgical treatment potentially represents an alternative to medical treatment. Here we discuss the results of the first 250 patients investigated in the presurgical epilepsy unit Geneva-Lausanne since its foundation in April 1995. Two thirds of these patients were adults and one third children and adolescents. In 85% of cases, non-invasive methods (Phase I) were sufficient for the diagnosis of the epileptic syndrome. In our unit non-invasive techniques include the following: prolonged Video-EEG monitoring, high resolution MRI, PET, neurological and neuropsychological evaluation during the ictal and interictal periods and a psychiatric examination. Globally, more than 90% of patients benefited significantly from the surgical intervention: 76% of patients were seizure free and 18% significantly improved. A psychiatric evaluation was also systematically carried out and demonstrated that two thirds of the examined patients suffered from a concomitant psychiatric disorder. Depression was encountered most often (31%). The necessity of a rapid diagnosis of pharmacoresistant epilepsy, amenable to surgical treatment, is discussed in order to obtain an optimal seizure control and preservation of the integrity of cognitive functions.