Purpose of Review: This article outlines indications for neurosurgical treatment of epilepsy, describes the presurgical workup, summarizes surgical approaches, and details expected risks and benefits.
Recent Findings: There is class I evidence for the efficacy of temporal lobectomy in treating intractable seizures, and accumulating documentation that successful surgical treatment reverses much of the disability, morbidity, and excess mortality of chronic epilepsy.
Summary: Chronic, uncontrolled focal epilepsy causes progressive disability and increased mortality, but these can be reversed with seizure control. Vigorous efforts to stop seizures are warranted. If two well-chosen and tolerated medication trials do not achieve seizure control, an early workup for epilepsy surgery should be arranged. If this workup definitively identifies the brain region from which the seizures arise, and this region can be removed with a low risk of disabling neurologic deficits, neurosurgery will have a much better chance of stopping seizures than further medication trials.
Address correspondence to Dr John W. Miller, Harborview Medical Center, Box 359745, 325 Ninth Avenue, Seattle, WA 98104, firstname.lastname@example.org.
Relationship Disclosure: Dr Miller receives research support from the Centers for Disease Control and Prevention, the NIH, Sunovian Pharmaceuticals, Inc, and UCB. Dr Hakimian has served as a consultant for OptumRx, Inc, and receives grants from the NIH.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Miller and Hakimian report no disclosures.