Surgical options for uncontrolled epilepsy

Surgical management of refractory epilepsy has undergone many modifications since it was instituted for the treatment of post-traumatic seizures many decades ago. Localization of onset of all seizures to a single resectable area of brain by various noninvasive and invasive recording methods is a complicated and controversial area, but guidelines are available. Success is correlated with accurate location and complete resection of the focus. When this is accomplished, resective surgery for epilepsy can provide cure or over 95 per cent reduction in seizure frequency in 60 to 90 per cent of patients undergoing these procedures. Although most often applied to temporal lobe foci, resections may be done in any cerebral lobe in the dominant or nondominant hemisphere with appropriate modifications of the evaluation and surgical procedure. When patients have unlocalizable or unresectable foci, depending on their exact pattern of seizures, electrical abnormalities, and neurologic status, other procedures may be used for surgical control of seizures. These include hemispherectomy, corpus callosum section, or stereotaxic procedures. The risks of all evaluation and surgical approaches are well balanced by the benefits obtained in a large proportion of patients.