Epilepsy surgery in adults

Introduction
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By Kristen Upchurch MD

Epilepsy surgery continues to expand in clinical use as an effective treatment for correctly selected patients with medically intractable and disabling focal epilepsy. In a broad overview, Dr. Kristen Upchurch and Dr. John Stern of UCLA discuss the history of epilepsy surgery, its scientific basis, indications, presurgical evaluation, and surgical approaches for both mesial temporal lobe epilepsy and neocortical focal epilepsies. Though resective epilepsy surgery has become an important conventional treatment option, it continues to be underutilized. This review details expected postoperative seizure control and quality-of-life outcomes, showing quantitatively how epilepsy surgery benefits patients. Updates for 2008 include new data on postoperative outcomes for resective epilepsy surgery, emphasizing results from the ongoing prospective Multicenter Study of Epilepsy Surgery. New information about seizure control after operative treatment of epileptogenic cavernous malformations is also discussed. Other updates for 2008 concern the novel presurgical diagnostic modality of simultaneous electroencephalography and functional magnetic resonance imaging, currently developing in its clinical utility.