Surgery for epilepsy dates back to 1886 and has undergone significant developments. Today it is considered
a key treatment modality in patients who are resistant to pharmacological intervention. It improves seizure
control, cognition and quality of life. New technologies, advances in surgical technique and progress in scientific
research underlie the expansion of surgery in epilepsy treatment. Effectiveness of surgical treatment depends on
several factors including the type of epilepsy, the underlying pathology and the localisation of the epileptogenic
zone. Timely referral to an experienced epilepsy surgery centre is important to allow the greatest chance of seizure
control and to minimise associated morbidity and mortality. Following referral, patients undergo thorough
presurgical investigation to evaluate their suitability for surgery. The commonest form of epilepsy treated by
surgery is mesial temporal lobe sclerosis and there is Class I evidence for the medium-term efficacy of temporal
lobe resection from two randomised control trials. Various other forms of epilepsy are now considered for resective
and neuromodulatory surgical intervention due to favourable results. In this article, the authors review the
current status of surgical treatment for epilepsy including the presurgical evaluation of patients, surgical techniques
and the future directions in epilepsy surgery.
Keywords: Epilepsy, surgery, temporal lobe, deep brain stimulation, vagal nerve stimulation, seizure.
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