Multiple subpial transection in patients with extratemporal epilepsy

Multiple subpial transection (MST) was developed to permit the treatment of partial epilepsies that reside in or encroach on eloquent cortex (language and sensorimotor cortex). It was conceived after the discoveries of the columnar organization of neocortex and that expression and spread of seizures utilize the transverse fiber network. Although the technique is simple in principle, it takes a skilled and practiced hand to avoid damage to the neocortical columns and vascular supply. The efficacy in controlling seizures with MST in extratemporal epilepsy is similar to that of resective surgery. Activities of daily living are not adversely impacted by MST. MST is a viable alternative to resection in extratemporal epilepsy.