Epilepsy Surgery

Surgical treatment of drug-resistant focal epilepsy is effective and is underutilised. People whose seizures have not been controlled by 2-3 antiseizure medications should be referred for evaluation for surgery, and up to half of them are likely to be suitable for resection. Suitability is assessed through a multidisciplinary evaluation, which includes a detailed history and examination, video and EEG recordings of seizures, MRI, neuropsychological, and neuropsychiatric evaluations. In some individuals, further investigations, including intracranial EEG, are necessary to identify the epileptogenic zone that needs to be removed. Decisions about resection need to weigh up the chances of control of seizures against possible adverse effects. Surgical aftercare includes rehabilitation, managing adjustment to a new situation and consideration of antiseizure medication changes. In individuals with drug-resistant focal epilepsy who are not suitable for potentially curative resections, palliation with neuromodulation may be helpful.