Surgery for epilepsy: a review

Abstract

This year marks the centennial of the first surgical resection for epilepsy performed by Horsley. While epilepsy is generally considered a disease best treated with anticonvulsant medications, surgical therapy is of significant benefit to some patients in whom medical therapy has proved ineffective. Anterior temporal lobectomy has been the single most successful operation commonly performed today. In this paper we review current techniques of preoperative evaluation, the role of scalp and intracranial electrophysiologic monitoring, as well as the contribution of PET and MRI scanning to improving the selection of patients for surgical therapy. The role of focal cortical excisions, hemispherectomy, and corpus callosotomy in the surgical armamentarium is also outlined. A plea is made for establishment of additional regionalized centers for epilepsy surgery in which close collaboration among neurologists, neuropsychologists, neurosurgeons and neurophysiologists can enhance patient care and advance our knowledge of the partial epilepsies and human cerebral function.

Deep learning applied to whole‐brain connectome to determine seizure control after epilepsy surgery

“…For patients with epilepsy who do not achieve seizure control after adequate treatment with up to 2 first‐line antiepileptic medications, epilepsy surgery may lead to seizure freedom . For mesial temporal lobe epilepsy (TLE), one of the most common forms of medication refractory epilepsy in adults, surgery can lead to cure of seizures for 60%‐70% of patients . Among patients with TLE, the presence of unilateral hippocampal atrophy and concordant side of seizure onset on ictal scalp electroencephalography (EEG) are well‐defined predictors of good seizure control with surgery …”

Excitotoxic Amino Acid Receptors in Human Complex Partial Epilepsy

“…Patients were evaluated as candidates for surgery by means of previously described protocols using both tests of epileptic excitability as well as focal cerebral dysfunction [5]. Anterior temporal lobectomy was performed using en bloc technique.…”

The brain connectome as a personalized biomarker of seizure outcomes after temporal lobectomy

“…[1][2][3][4] Uncontrolled epilepsy is associated with significant psychosocial disability 5 and, for this reason, the American Academy of Neurology recommends that patients should be referred for surgery within 1 year of the diagnosis of refractory epilepsy. 6 However, in the United States, patients are typically referred for surgery only after 10-20 years of recurrent seizures, 7 when it is too late to prevent the long-term consequences of epilepsy.…”