SURGICAL TREATMENT OF THERAPY-RESISTANT EPILEPSY

Abstract

ABSTRACT Epilepsy neurosurgery is a therapeutic option for patients with seizures resistant to medical therapy. Surgical therapy should be considered in therapy-resistant patients with epilepsy because of the increased mortality (conservatively 0.5% per year), and progressive cognitive and psychosocial morbidity associated with uncontrolled seizures over many years. Patients who continue to have disabling seizures after failure of two to three antiepileptic drugs should be evaluated at a specialty epilepsy center that offers surgery. In particular circumstances, such as catastrophic epilepsy in young children, patients ought to be urgently referred because of the risk of severe developmental disability. Epilepsy surgery encompasses a variety of resective and palliative operative procedures, and no age or gender restrictions exist. Depending on the seizure syndrome and operative procedure, 50% to 70% of patients can expect to become seizure free after resective surgery, which is superior to continued medical therapy. Surgical therapy has improved with time because of new technologies, such as neuroimaging and better operative techniques. Operative-related morbidity and mortality are generally under 5%, which is less than the risk of death from refractory epilepsy over the course of many years. Epilepsy neurosurgery, therefore, is not the treatment of last resort. Instead, surgery is a tool in the treatment of patients who are medically intractable and should be considered early in those patients with a high risk of therapy resistance to reduce seizure-related morbidity and mortality.