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Epilepsy Surgery in 2004

Recent advances in preoperative localization of epileptogenic foci have created a resurgence of interest in the surgical treatment of intractable epilepsy. Multiple subpial transection has provided a surgical option for the patients whose epileptogenic zone resides in the functional cortex. Neurostimulation therapy is an emerging modality in the treatment of epilepsy, allowing maximal preservation of cerebral tissue. In addition to vagus nerve stimulation, other modalities are being investigated, including stimulation of the anterior and centromedian nuclei of the thalamus, the hippocampus, the subthalamic nucleus, and the cerebral cortex. The feasibility and potential efficacy of cortical stimulation for the treatment of localization-related epilepsy have been shown in preliminary studies. In this review, the authors present the more current surgical approaches and their indications for the treatment of medically intractable epilepsy. Seizure focus resection remains the most reasonable approach to therapy for the patients with an epileptogenic zone in dispensable or free-functional cortex.