Surgical treatment of epilepsy

Epilepsy is common disorder defined as recurrent, unprovoked seizures, with many etiologies including genetic and acquired conditions. It causes not only seizures but also deficits in patients cognition, mood and socioeconomic status. Treatment of epilepsy includes anti-epileptic medications as well as numerous surgical interventions. Before undertaking any surgical intervention, one must fail maximal medical therapy, after which they undergo a battery of diagnostic tests to guide surgical planning. These diagnostic tests include functional tests such as electroencephalography (both non-invasive surface EEG and invasive subdural or depth electrodes), functional MRI, the Wada test, and neuropsychological testing and MRI. There are many options for surgical intervention including neuroablation, neuromodulation and resection. Neuroablation can be performed via radiofrequency thermocoagulation, magnetic resonance-guided focused ultrasound surgery, laser ablation and stereotactic radiosurgery. Neuromodulation includes vagal nerve stimulation (VNS) and deep brain stimulation (DBS). Epilepsy surgery includes temporal lobectomy, hemispherectomy, and corpus callosotomy. Outcomes after surgery have been modest, and they continue to improve. Below we describe in further detail the background of epilepsy patients as well as the diagnostic and treatment modalities.