Use of Surgical Procedures in the Treatment of Epilepsy: Interventions and Outcomes

Medically intractable epilepsy (MIE) is a chronic disabling condition that primarily affects the young. Inadequately treated, it can produce life-long disability associated with high rates of social isolation, unemployment, depression, suicide and premature mortality. Recent advances in technology and in our understanding of underlying MIE syndromes have significantly expanded the availability of a variety of surgical approaches worldwide for the treatment of this condition, but surgery may still be underutilised. Surgery can safely and completely control seizures or significantly reduce their frequency in 50 to 90% of cases, depending on the type of syndrome. Without surgery, such patients have a <15% chance of being seizure-free with further trials of medication. This article reviews the indications and principles of surgical evaluation and the existing evidence for effectiveness and cost effectiveness, focusing particularly on studies of patients treated after the advent of modern neuroimaging techniques. To avoid development of disability, early referral for evaluation is recommended for patients with syndromes that have proven particularly responsive to surgery. Principles of comprehensive treatment and one centre's experience with disease management are briefly discussed.