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Surgical treatment of epilepsy in adults

Author
Gregory D Cascino, MD
Section Editor
Timothy A Pedley, MD
Deputy Editor
April F Eichler, MD, MPH

INTRODUCTION

Epilepsy is one of the most common chronic neurological disorders, and approximately 20 to 30 percent of patients with epilepsy will have medically and socially disabling seizure disorders. Such patients are at increased risk for serious morbidity and mortality, including cognitive disorders, depression, physical trauma, and sudden death in epilepsy. The goals of treatment for individuals with drug-resistant epilepsy are to render the patient seizure-free, avoid treatment-related adverse effects, and allow the individual to become a participating and productive member of society.

Most individuals who will respond favorably to antiseizure drugs are successfully managed within the first two years of treatment. Patients who do not respond favorably to two antiseizure drugs used appropriately are likely to have drug-resistant epilepsy and should be investigated for surgery and other alternative forms of treatment.

Surgical therapy is an important and underutilized treatment in patients with drug-resistant focal epilepsy. Surgical procedures for epilepsy range from focal resection of the epileptogenic cortex (antero-mesial temporal lobe and other focal cortical resections) to interventions that remove or isolate the cortex of a grossly diseased hemisphere (functional hemispherectomy, anterior corpus callosotomy, multiple subpial transections). The latter procedures are most often performed in children and are not discussed further here. In general, only complete resection of the epileptogenic brain region offers the chance of long-term seizure freedom.

This topic will discuss the surgical treatment of drug-resistant focal epilepsy in adults utilizing focal cortical resection. Epilepsy surgery in children and other aspects of epilepsy management and treatment in adults are discussed separately. (See "Overview of the management of epilepsy in adults" and "Evaluation and management of drug-resistant epilepsy" and "Seizures and epilepsy in children: Refractory seizures and prognosis", section on 'Epilepsy surgery'.)

SURGICAL CANDIDATES

Focal cortical resection is a consideration in patients with drug-resistant focal epilepsy if the seizures emanate from a region that can be removed with minimal risk of disabling neurologic or cognitive dysfunction.

                              

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 07 00:00:00 GMT+00:00 2016.
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