Surgery for epilepsy.

The National Institutes of Health Consensus Development Conference on Surgery for Epilepsy brought together neurologists, neurosurgeons, psychologists, other health care providers, and the public to address issues regarding epilepsy surgery including patient selection and management, localization of seizure site onset, appropriate diagnostic techniques, and postoperative outcome assessment. The panel concluded that brain surgery is an alternative treatment when medication fails. Seizure frequency, severity type, possible brain damage or injury from frequent seizures, and effect on quality of life all must be considered in deciding to evaluate for surgery. An appropriate medication trial must have been conducted, using the correct drugs for the patient's seizure type at adequate doses and blood levels. Non-epileptic attacks must be ruled out, and diagnostic tests to detect any underlying cause should be performed. If surgery is considered, patients should be evaluated by a team including neurologists, neurosurgeons, neuropsychologists, social workers, and, if needed, psychiatrists. Assessment of outcome should include standardized methods of information collection. Measures assessing quality of life and overall health status can compare epilepsy to other chronic conditions. Assessment of economic and social impact on the patient's family should be included.