|Challenges of Epilepsy Surgery.
|Year of Publication
|Kuzan-Fischer CM, Parker WE, Schwartz TH, Hoffman CE
|Age Factors, Drug Resistant Epilepsy, Electroencephalography, Encephalitis, Endometrial Ablation Techniques, Functional Laterality, Functional Neuroimaging, Humans, Implantable Neurostimulators, Magnetic Resonance Imaging, Magnetoencephalography, Neuropsychological Tests, Neurosurgical Procedures, Patient Selection, Positron-Emission Tomography, Prosthesis Implantation, Referral and Consultation, Tomography, Emission-Computed, Single-Photon, Treatment Failure, Tuberous Sclerosis
Though frequently effective in the management of medically refractory seizures, epilepsy surgery presents numerous challenges. Selection of the appropriate candidate patients who are likely to benefit from surgery is critical to achieving seizure freedom and avoiding neurocognitive morbidity. Identifying the seizure focus and mapping epileptogenic networks involves an interdisciplinary team dedicated to formulating a safe and effective surgical plan. Various strategies can be employed either to eliminate the epileptic focus or to modulate network activity, including resection of the focus with open surgery or laser interstitial thermal therapy; modulation of epileptogenic firing patterns with responsive neurostimulation, deep brain stimulation, or vagus nerve stimulation; or non-invasive disconnection of epileptic circuits with focused ultrasound, which is also discussed in greater detail in the subsequent chapter in our series. We review several challenges of epilepsy surgery that must be thoughtfully addressed in order to ensure its success.