Update on the Surgical Treatment of Epilepsy
Update on the Surgical Treatment of Epilepsy
Purpose of review Using the most recent evidence, we provide an update about epilepsy surgery, focusing on the presurgical evaluation and surgical planning, epilepsy surgery outcomes, and utilization.
Recent findings Great strides are being achieved in the presurgical evaluation and planning for epilepsy surgery, including fundamental advances in imaging and neurophysiology. A recent randomized controlled trial demonstrates that early surgery for patients with mesial temporal lobe epilepsy (TLE) is superior to medical therapy. The enduring benefits of surgery continue to be demonstrated, particularly after TLE surgery. However, studies examining the long-term outcomes after extratemporal lobe epilepsy surgery are scarce. Surgery is generally associated with an improvement in depression, but mostly in those with good surgical outcome. Complications from invasive monitoring or after epilepsy surgery are generally temporary, or limited in their symptomatology. One area in need of prospective studies is the topic of antiepileptic drug withdrawal after epilepsy surgery (Who? When? How?). Despite its proven effectiveness, epilepsy surgery continues to be underutilized, but new tools for health professionals are emerging to guide appropriate surgical referrals.
Summary Important contributions to the field of epilepsy surgery are discussed, in particular emerging imaging (fMRI) and neurophysiological (high-frequency oscillations) techniques. Epilepsy surgery is effective, well tolerated but still underutilized.
Important challenges in resective epilepsy surgery include understanding the long-term outcomes, improving the outcomes in patients with nonlesional or nonfocal findings, lowering the chance of neurological deficits, and improving the underutilization of this highly effective intervention. We discuss important contributions in the field of epilepsy surgery made within the last year, with a particular focus on surgical evaluation and planning, outcomes, and utilization. The search strategy for this review was as follows, and resulted in 939 abstracts:
For further background on epilepsy surgery, the reader may consult other recent reviews discussing the indications, approaches, and outcomes of epilepsy surgery.
Abstract and Introduction
Abstract
Purpose of review Using the most recent evidence, we provide an update about epilepsy surgery, focusing on the presurgical evaluation and surgical planning, epilepsy surgery outcomes, and utilization.
Recent findings Great strides are being achieved in the presurgical evaluation and planning for epilepsy surgery, including fundamental advances in imaging and neurophysiology. A recent randomized controlled trial demonstrates that early surgery for patients with mesial temporal lobe epilepsy (TLE) is superior to medical therapy. The enduring benefits of surgery continue to be demonstrated, particularly after TLE surgery. However, studies examining the long-term outcomes after extratemporal lobe epilepsy surgery are scarce. Surgery is generally associated with an improvement in depression, but mostly in those with good surgical outcome. Complications from invasive monitoring or after epilepsy surgery are generally temporary, or limited in their symptomatology. One area in need of prospective studies is the topic of antiepileptic drug withdrawal after epilepsy surgery (Who? When? How?). Despite its proven effectiveness, epilepsy surgery continues to be underutilized, but new tools for health professionals are emerging to guide appropriate surgical referrals.
Summary Important contributions to the field of epilepsy surgery are discussed, in particular emerging imaging (fMRI) and neurophysiological (high-frequency oscillations) techniques. Epilepsy surgery is effective, well tolerated but still underutilized.
Introduction
Important challenges in resective epilepsy surgery include understanding the long-term outcomes, improving the outcomes in patients with nonlesional or nonfocal findings, lowering the chance of neurological deficits, and improving the underutilization of this highly effective intervention. We discuss important contributions in the field of epilepsy surgery made within the last year, with a particular focus on surgical evaluation and planning, outcomes, and utilization. The search strategy for this review was as follows, and resulted in 939 abstracts:
epilepsy AND (surgery or nonresective or radiosurgery or hippocampal stimulation or thalamic stimulation or implantable device);
limits: English only and published between 1 September 2011 and 15 September 2012.
For further background on epilepsy surgery, the reader may consult other recent reviews discussing the indications, approaches, and outcomes of epilepsy surgery.
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