Surgical considerations in the management of epilepsy

Abstract

There is class I evidence to support the use of surgery in the management of medically refractory epilepsy, with better clinical outcomes and cost effectiveness. Despite this, surgery remains an underutilised resource. One reason is that epilepsy is a complex and heterogeneous condition, and individuals require comprehensive pre-operative evaluation to determine whether surgery is appropriate for them. Surgery may be curative, with the aims of achieving seizure freedom, or palliative, with the aim of reducing seizure frequency. Surgery may also be diagnostic, with intracranial EEG playing an important role in the presurgical evaluation. In this article, the process of presurgical evaluation is summarised, followed by an overview of current surgical treatments available.