Continuing Medical Education
Surgical management of epilepsy
The fact that epilepsy can be cured or ameliorated with surgery is an often neglected and overlooked aspect of modern management.
Epilepsy affects almost 50 million people worldwide. One-third of people who suffer from epilepsy are refractory to medication alone. It
is this group of patients who may benefit from epilepsy surgery, which can be divided into three main categories, i.e. resection procedures,
disconnection procedures, and neuromodulation procedures. The goal of surgery in epilepsy is to remove the epileptogenic region from the
brain, or to disconnect it and thereby prevent spread to other parts of the brain. In cases where this is not possible owing to the location of
the epileptic focus, certain neuromodulation techniques may benefit the patient. Successful outcomes of epilepsy surgery techniques vary
from 50% to 80% in rendering patients free of their epilepsy; many more patients can expect improvement in the severity or frequency of
their disabling seizures. The outcome depends on factors such as age, location of the epileptogenic zone, histology and cause of the seizures.
Patients undergo a detailed and prolonged work-up to determine candidacy and to decide on the safest technique that will lead to the best
outcomes. An experienced team should perform the surgery. This team should consist of multiple members who can attend to the medical,
social, psychological and reintegration needs of the patient before and after surgery.
J M Nico Enslin, Division of Neurosurgery, Red Cross War Memorial Children’s Hospital, and Constantiaberg Mediclinic, Cape Town
Sally J Rothemeyer, Department of Neurosurgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town
A Graham Fieggen, Department of Neurosurgery, Faculty of Health Sciences, University of Cape Town, and Division of Neurosurgery, Red Cross War Memorial Children’s Hospital, Cape Town
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Date published: 2016-07-11
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