Surgical treatment of medically intractable epilepsy

The objective of surgical treatment of epilepsy is better or complete seizure control and improvement of the quality -of-life of patients with medically intractable epilepsy. Failure of at least 2-3 antiepileptic drugs of first choice in monotherapy together with many other important prognostic factors determine the medical intractibility of epilepsy in children and poor prognosis of the disease. A careful diagnostic evaluation is mandatory for identification of surgical candidates and localizing the epileptogenic zone. Preoperative assessment should also define precisely some vital parts of the brain which should remain preserved after the operation such as cortical areas for speech, sight and memory functions. Non-invasive as well as invasive diagnostic preoperative procedures are described in detail and possibly resectable lesions are defined. It has been clearly demonstrated already that epilepsy surgery is an effective and safe treatment although some complications may appear. Neurosurgical procedures in treating intractable epilepsy can be divided in to resective and disconnection techniques. Known postoperative results lead to seizure freedom in more than 70% of patients who suffer from temporal lobe epilepsy (TLE) and in 40 to 70% of those who suffer from extra-temporal neocortical epilepsy. The results of epilepsy surgery in children are significantly better than in adults. Favourable outcomes always exceed 50%, sometimes 90% in well chosen cases with certain techniques. This success is made possible by the extraordinary brain plasticity in childhood and renewal of damaged brain functions. Medically intractable epilepsy causes stagnation of psychomotor and social development of the child. If acceptable seizure control is not achieved, a child should be referred to an epilepsy surgery centre for further evaluation.

Category: Review
Volume: Vol. 53, No 3, july - september 2009
Authors: M. Jurin
Reference work:

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