Seizure surgery

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 may be helpful in patients with focal epilepsy if:^[1]
  • The brain region that is the seizure origin can be safely removed.
  • There is no seizure control after two or more antiepileptic drugs (AEDs).
    • Two randomized controlled trials showed that the rate of seizure freedom in patients with temporal lobe epilepsy that had surgery was 60% to 85%, compared with 0% to 8% to those that had continued medical treatment.^[2][3]

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]

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

• Vagus nerve stimulation:
  • Surgical placement of a subcutaneous stimulator in the chest and a stimulating wire in the neck (the vagus nerve).
• Responsive neurostimulation device:
  • Directly detects seizures with implanted intracranial electrodes.^[5]