Seizure surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Overview

Surgery may be helpful in patients with focal epilepsy if there is no seizure control after two or more antiepileptic drugs (AEDs). Laser interstitial thermal ablation and neurostimulation may be helpful as alternative therapies to surgery in some patients.

Surgery

Surgery

Laser Interstitial Thermal Ablation

Laser interstitial thermal ablation may be helpful as an alternative therapy to surgery in patients with some types of focal epilepsy.[1]

  • With MRI guidance a thermal probe targeting the seizure origin is placed and then heat is ablates the tissue.[4]

Neurostimulation

Patients that are not candidates for surgery may be treated with neurostimulation:[1]

References

  1. 1.0 1.1 1.2 Johnson EL (2019). "Seizures and Epilepsy". Med Clin North Am. 103 (2): 309–324. doi:10.1016/j.mcna.2018.10.002. PMID 30704683.
  2. Engel J, McDermott MP, Wiebe S, Langfitt JT, Stern JM, Dewar S; et al. (2012). "Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial". JAMA. 307 (9): 922–30. doi:10.1001/jama.2012.220. PMC 4821633. PMID 22396514.
  3. Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group (2001). "A randomized, controlled trial of surgery for temporal-lobe epilepsy". N Engl J Med. 345 (5): 311–8. doi:10.1056/NEJM200108023450501. PMID 11484687.
  4. Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C; et al. (2014). "Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy". Neurosurgery. 74 (6): 569–84, discussion 584-5. doi:10.1227/NEU.0000000000000343. PMC 4151501. PMID 24618797.
  5. Ben-Menachem E, Krauss GL (2014). "Epilepsy: responsive neurostimulation-modulating the epileptic brain". Nat Rev Neurol. 10 (5): 247–8. doi:10.1038/nrneurol.2014.69. PMID 24752127.