Epilepsy surgery. Issue 1 (16th August 2019)

• Record Type: Journal Article
• Authors: Rugg-Gunn, Fergus; Miserocchi, Anna; McEvoy, Andrew
• Is Part Of: Practical neurology. Volume 20:Issue 1(2020)
• Page Start: 4
• Page End: 14
• Publication Date: 2019-08-16
• Subjects: epilepsy -- epilepsy surgery; Neurology -- Periodicals; 616.8005
• DOI: 10.1136/practneurol-2019-002192
• Languages: English
• ISSNs: 1474-7758

Abstract

Abstract : Epilepsy surgery offers the chance of seizure remission for the 30%–40% of patients with focal epilepsy whose seizures continue despite anti-epileptic medications. Epilepsy surgery encompasses curative resective procedures, palliative techniques such as corpus callosotomy and implantation of stimulation devices. Pre-surgical evaluation aims to identify the epileptogenic zone and to prevent post-operative neurological and cognitive deficits. This entails optimal imaging, prolonged video-electroencephalogram (EEG) recordings, and neuropsychological and psychiatric assessments; some patients may then require nuclear medicine imaging and intracranial EEG recording. The best outcomes are in those with an electro-clinically concordant structural lesion on MRI (60%–70% seizure freedom). Lower rates of seizure freedom are expected in people with extra-temporal lobe foci, focal-to-bilateral tonic-clonic seizures, normal structural imaging, psychiatric co-morbidity and learning disability. Nevertheless, surgery for epilepsy is under-used and should be considered for all patients with refractory focal epilepsy in whom two or three anti-epileptic medications have been ineffective.