The preoperative evaluation and surgical treatment of epilepsy

One-third of all patients with epilepsy have persistent seizures despite medical treatment. If the origin of the seizures can be localized to a particular site in the brain, epilepsy surgery is a treatment option that addresses the cause of the problem.

The presurgical assessment and surgical treatment of epilepsy are discussed on the basis of a selective literature review and the authors' clinical experience.

Recent studies give further evidence that surgical treatment is superior to continued medical treatment for patients with seizures of focal origin that persist despite treatment with two antiepileptic drugs. Modern imaging and electrophysiological techniques enable the demonstration of subtle structural and functional changes of the cerebral cortex as a basis for individually tailored surgical resection. 60-80% of surgically treated patients become seizure-free. According to recent reviews, epilepsy surgery is associated with a permanent morbidity of 6% and with a mortality well under 1%; these figures are in the typical range for neurosurgical procedures. In the authors' series, 2% of patients had permanent complications, and the death rate was less than 0.1%.

Advances in presurgical assessment and the broad range of available surgical techniques have widened the applicability of surgical treatment for children and adults with medically refractory epilepsy. Patients should be referred early in the course of their disease to an epilepsy center for evaluation of the surgical options.