Epilepsy surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Surgery is not the first-line treatment option for patients with epilepsy. Surgery is usually reserved for patients who their seizure continues to happen despite using maximum dosage of anti-seizure drugs.

Indication

Surgery is not the first-line treatment option for patients with epilepsy. Surgery is usually reserved for patients who their seizure continues to happen despite using maximum dosage of anti-seizure drugs.^[1]

Surgery

The goal of surgery in epilepsy can be divided into two categories:

Curative
- Lesional resection
- Lobectomy
- Corticectomy
- Hemispheric disconnection
- Multiple subpial transactions
- Gamma knife radiosurgery
Palliative
- Hemispheric surgery
- Multiple subpial transections
- Disconnection procedures such as callosotomy
- Stimulation procedures including vagal nerve stimulation and deep brain stimulation^[1]

Contraindications

Contraindications for vagal nerve stimulation includes:

Cardiac arrhythmias
Respiratory diseases such as asthma
Hoarseness
Gastric ulcers
vasovagal syncope
Previous left or bilateral cervical vagotomy
Progressive intracerebral disease ^[2]

Contraindications for deep brain stimulation includes:

Unstable heart disease
Active infection
Significant subcortical arteriosclerotic encephalopathy
malignancy with markedly reduced life expectancy
Abnormal findings on presurgical imaging (except for minor atrophy)^[3]^[4]

References

↑ ^1.0 ^1.1 McKhann GM, Bourgeois BF, Goodman RR (September 2002). “Epilepsy surgery: indications, approaches, and results”. Semin Neurol. 22 (3): 269–78. doi:10.1055/s-2002-36653. PMID 12528052.
↑ Boon PA (September 2001). “Vagus nerve stimulation for refractory epilepsy”. J Clin Neurophysiol. 18 (5): 393. PMID 11709642.
↑ Landi A, Parolin M, Piolti R, Antonini A, Grimaldi M, Crespi M, Iurlaro S, Aliprandi A, Pezzoli G, Ferrarese C, Gaini SM (May 2003). “Deep brain stimulation for the treatment of Parkinson’s disease: the experience of the Neurosurgical Department in Monza”. Neurol. Sci. 24 Suppl 1: S43–4. doi:10.1007/s100720300039. PMID 12774214.
↑ Lang AE, Houeto JL, Krack P, Kubu C, Lyons KE, Moro E, Ondo W, Pahwa R, Poewe W, Tröster AI, Uitti R, Voon V (June 2006). “Deep brain stimulation: preoperative issues”. Mov. Disord. 21 Suppl 14: S171–96. doi:10.1002/mds.20955. PMID 16810718.

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[pmid12528052-1] 1.0 ^1.1 McKhann GM, Bourgeois BF, Goodman RR (September 2002). “Epilepsy surgery: indications, approaches, and results”. Semin Neurol. 22 (3): 269–78. doi:10.1055/s-2002-36653. PMID 12528052.

[pmid11709642-2] Boon PA (September 2001). “Vagus nerve stimulation for refractory epilepsy”. J Clin Neurophysiol. 18 (5): 393. PMID 11709642.

[pmid12774214-3] Landi A, Parolin M, Piolti R, Antonini A, Grimaldi M, Crespi M, Iurlaro S, Aliprandi A, Pezzoli G, Ferrarese C, Gaini SM (May 2003). “Deep brain stimulation for the treatment of Parkinson’s disease: the experience of the Neurosurgical Department in Monza”. Neurol. Sci. 24 Suppl 1: S43–4. doi:10.1007/s100720300039. PMID 12774214.

[pmid16810718-4] Lang AE, Houeto JL, Krack P, Kubu C, Lyons KE, Moro E, Ondo W, Pahwa R, Poewe W, Tröster AI, Uitti R, Voon V (June 2006). “Deep brain stimulation: preoperative issues”. Mov. Disord. 21 Suppl 14: S171–96. doi:10.1002/mds.20955. PMID 16810718.

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