Surgical Treatments for Epilepsy.

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Despite numerous antiseizure medications approved by the FDA, outcomes for newly diagnosed epilepsy have stagnated.
• Drug-resistant epilepsy affects up to 40% of patients, highlighting a significant unmet need.
• Epilepsy surgery is underutilized despite strong evidence supporting its efficacy.

Purpose of the Study:

• To outline indications for epilepsy surgery.
• To describe the presurgical workup process.
• To summarize current surgical approaches for epilepsy.

Main Methods:

• Review of Class I evidence comparing surgical interventions to medical therapy.
• Analysis of minimally invasive surgical options.
• Evaluation of neuromodulation techniques as alternatives.

Main Results:

• Class I evidence confirms resective surgery's superiority over medical therapy for seizure control and quality of life.
• Minimally invasive techniques (laser interstitial thermal therapy, stereotactic radiosurgery) and neuromodulation (responsive neurostimulation, deep brain stimulation, vagus nerve stimulation) are viable alternatives.
• Neuromodulation reduces seizure frequency but is less likely to achieve seizure freedom compared to resective surgery.

Conclusions:

• Patients with drug-resistant epilepsy significantly benefit from surgical intervention.
• Referral to a comprehensive epilepsy center is appropriate after two failed medication trials.
• Epilepsy surgery provides a substantially higher chance of seizure freedom than continued medical management.