Epilepsy surgery

The publication of many review papers and five books on the surgical treatment of epilepsy during the past year attests to the tremendous increase in interest in this alternative mode of therapy. The number of therapeutic surgical procedures in the United States alone has more than tripled since 1986; however, there may be 10- to 100-fold more patients who could benefit from surgical intervention. Advances in diagnostic testing and surgical technique have greatly improved the safety and efficacy of surgical treatment, particularly for clearly defined, surgically remediable syndromes such as mesial temporal lobe epilepsy and certain pediatric disorders. Greater efforts must now be made to 1) communicate these advances to primary care physicians in order to identify appropriate surgical candidates early in the course of their disorder, and 2) document the cost-effectiveness of surgical treatment in order to justify compensation by third-party payers.