Charles E Polkey1. 1. Academic Neuroscience Centre, Institute of Psychiatry, Denmark Hill, London, UK. polleyce@aol.com
Abstract
PURPOSE OF REVIEW: The outcome from current surgical methods of treating drug-resistant epilepsy will be considered, looking at changes in classical resective surgery and new methodology being introduced in the functional treatment of these patients. RECENT FINDINGS: There is now class I evidence that temporal lobe surgery is effective. Sophisticated and appropriate magnetic resonance imaging sequences, together with an assessment of the electroclinical syndrome, allow patients to be assessed for resective surgery. The concept of 'surgically remediable syndromes' determines the type of procedure that is effective for particular patients. Technical advances such as neuronavigation techniques and intra-operative magnetic resonance imaging have improved the effectiveness of these procedures. Other techniques of disconnection, such as multiple subpial transection, and stimulation both indirectly using the vagus nerve and directly using various intracranial targets, are currently effective and have potential for future development. SUMMARY: This review will demonstrate that current surgical techniques are safe and effective in relieving drug-resistant epilepsy.
PURPOSE OF REVIEW: The outcome from current surgical methods of treating drug-resistant epilepsy will be considered, looking at changes in classical resective surgery and new methodology being introduced in the functional treatment of these patients. RECENT FINDINGS: There is now class I evidence that temporal lobe surgery is effective. Sophisticated and appropriate magnetic resonance imaging sequences, together with an assessment of the electroclinical syndrome, allow patients to be assessed for resective surgery. The concept of 'surgically remediable syndromes' determines the type of procedure that is effective for particular patients. Technical advances such as neuronavigation techniques and intra-operative magnetic resonance imaging have improved the effectiveness of these procedures. Other techniques of disconnection, such as multiple subpial transection, and stimulation both indirectly using the vagus nerve and directly using various intracranial targets, are currently effective and have potential for future development. SUMMARY: This review will demonstrate that current surgical techniques are safe and effective in relieving drug-resistant epilepsy.