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Innovations in the Neurosurgical Management of Epilepsy.

TitleInnovations in the Neurosurgical Management of Epilepsy.
Publication TypeJournal Article
Year of Publication2020
AuthorsHoffman CE, Parker WE, Rapoport BI, Zhao M, Ma H, Schwartz TH
JournalWorld Neurosurg
Volume139
Pagination775-788
Date Published2020 07
ISSN1878-8769
KeywordsDrug Resistant Epilepsy, Electrocorticography, High-Intensity Focused Ultrasound Ablation, Humans, Implantable Neurostimulators, Inventions, Neurosurgical Procedures, Optical Imaging, Optogenetics, Positron-Emission Tomography, Precision Medicine, Prosthesis Implantation, Robotic Surgical Procedures, Stereotaxic Techniques, Wireless Technology
Abstract

Technical limitations and clinical challenges have historically limited the diagnostic tools and treatment methods available for surgical approaches to the management of epilepsy. By contrast, recent technological innovations in several areas hold significant promise in improving outcomes and decreasing morbidity. We review innovations in the neurosurgical management of epilepsy in several areas, including wireless recording and stimulation systems (particularly responsive neurostimulation [NeuroPace]), conformal electrodes for high-resolution electrocorticography, robot-assisted stereotactic surgery, optogenetics and optical imaging methods, novel positron emission tomography ligands, and new applications of focused ultrasonography. Investigation into genetic causes of and susceptibilities to epilepsy has introduced a new era of precision medicine, enabling the understanding of cell signaling mechanisms underlying epileptic activity as well as patient-specific molecularly targeted treatment options. We discuss the emerging path to individualized treatment plans, predicted outcomes, and improved selection of effective interventions, on the basis of these developments.

DOI10.1016/j.wneu.2020.03.031
Alternate JournalWorld Neurosurg
PubMed ID32689698