Current Concepts

Surgical Management of Epilepsy

Authors: JOSEPH R. SMITH MD, HERMAN F. FLANIGIN MD, DON W. KING MD, BRIAN B. GALLAGHER MD, PhD, DAVID W. LORING PhD, KIMFORD J. MEADOR MD, ANTHONY M. MURRO MD, GREGORY P. LEE PhD

Abstract

ABSTRACT:About 300,000 people in the United States suffer from medically uncontrolled focal epilepsy. It is estimated that about 40,000 of these patients are candidates for surgery. Underuse of surgical treatment of epilepsy is reflected by the fact that only about 1% of these candidates are operated on. Candidates for ablative surgery (ie, removal of seizure focus) must have a focus demonstrated by either extracranial or intracranial electrode recordings. Nearly half of the patients who have ablative surgery become seizure-free, and nearly two thirds have no seizures or only rare ones. Candidates for corpus callosotomy are those patients with multiple seizure types and nonfocal EEG abnormalities. Almost half of these patients have at least a 50% reduction in seizure frequency. Patients with infantile hemiplegia and seizures may have marked improvement in seizure control after physiologic hemispherectomy.

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