J Korean Med Assoc.  2003 Apr;46(4):298-306. 10.5124/jkma.2003.46.4.298.

Epilepsy : Surgical Treatment

Affiliations
  • 1Department of Neurosurgery, Samsung Seoul Medical Cecter, Sungkyunkwan University School of Medicine, Korea. schong@smc.samsung.co.kr

Abstract

Interest in epilepsy surgery is getting more and more increased with the development of computer-EEG and neuroimaging technique. There is a definite subgroup of intractable epilepsy patients who can be treated by surgical treatment. Essential procedures for the satisfactory result of epilepsy surgery include strict patient selection, EEG analysis, anatomical/functional imaging for identification of epileptogenic lesions and seizure onset, neuropsychological test, and intracranial recording procedures. Temporal lobe epilepsy with typical hippocampal sclerosis is the best and most popular surgical candidate. Intractable epilepsy with focal discrete benign lesions (tumors, vascular malformations, granulomas, etc.) can also be good surgical candidates. Localization-related epilepsy with cortical dysplasia and other non-visible lesions can be treated by surgery through intracranial recording procedures. Callosotomy and hemispherectomy can be performed in selected patients with intractable generalized seizures. The importance of comprehensive preoperative investigations cannot be overemphasized.

Keyword

Epilepsy surgery; Indication; Neuroimaging; Hippocampal sclerosis; Lesion

MeSH Terms

Electroencephalography
Epilepsies, Partial
Epilepsy*
Epilepsy, Temporal Lobe
Granuloma
Hemispherectomy
Humans
Malformations of Cortical Development
Neuroimaging
Neuropsychological Tests
Patient Selection
Sclerosis
Seizures
Vascular Malformations

Reference

1. Engel J, Shewmon DA. Engel J, editor. Overview. Who should be considered a surgical candidate? Surgical Treatment of the Epilepsies. 1993. New York: Raven Press;23–43.
2. ILAE Commission Report. The epidemiology of the epilepsies: Future directions. Epilepsia. 1997. 38:614–618.
3. Munari C, Bancaud J. Electroclinical symptomatology of partial seizures of orbital frontal origin. Adv Neurol. 1992. 57:257–265.
4. Kotagal P, Luders H, Williams G, Nichols TR, McPherson J. Psychomotor seizures of temporal lobe onset: analysis of symptom clusters and sequences. Epilepsy Res. 1995. 20:49–67.
Article
5. Salanova V, Morris HH, Van Ness P, Kotagal P, Wyllie E, Luders H. Frontal lobe seizures: electroclinical syndromes. Epilepsia. 1995. 36:16–24.
Article
6. Jackson GD, Connelly A, Duncan JS, Grunewald RA, Gadian DG. Detection of hippocampal pathology in intractable partial epilepsy: increased sensitivity with quantitative magnetic resonance T2-relaxometry. Neurology. 1993. 43:1793–1799.
Article
7. Berkovic SF, Rowe CC. Disksic M, Reba RC, editors. The use of SPECT in focal epilepsy. Radiopharmaceuticals and brain pathology studies with PET and SPECT. 1991. CRC Press;257–266.
Article
8. Chugani HT, Shewmon DA, Peacock WJ, Shields WD, Mazziotta JC, Phelps ME. Surgical treatment of intractable neonatal-onset seizures: The role of positron emission tomography. Neurology. 1988. 38:1178–1188.
Article
9. Ojemann GA. Brain organization for language from the perspective of electrical stimulation mapping. Behav Brain Sci. 1983. 6:190–206.
Article
10. Luders H, Lesser RP, Dinner DS, Morris HH, Wyllie E, Godoy J. Localization of cortical function: new information from extraoperative monitoring of patients with epilepsy. Epilepsia. 1988. Suppl 2. s56–s65.
Article
11. Woolsey CN, Erickson TC, Gilson WE. Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg. 1979. 51:476–506.
Article
12. Jones-Gotman M. Localization of lesions by neuropsychological testing. Epilepsia. 1991. 32:Suppl 5. S41–S52.
13. Dodrill CB, Batzel LW, Fraser R. Luders H, editor. Psychosocial changes after surgery for epilepsy. Epilepsy Surgery. 1991. New York: Raven Press;661–667.
14. Ogawa S, Lee T-M, Nayak AS, Glynn P. Oxygen sensitive contrast in magnetic resonance image of rodent brain at high magnetic field. Magn Reson Med. 1990. 14:68–78.
Article
15. Connelly A, Jackson D, Duncan J, Gadian D. Magnetic resonance spectroscopy in temporal lobe epilepsy. Neurology. 1994. 44:1411–1417.
Article
16. Jack CJ, Sharbrough FW, Twomey CK, Cascino GD, Hirschorn KA, Marsh WR, et al. Temporal lobe seizures: lateralization with MR volume measurements of the hippocampal formation. Radiology. 1990. 175:423–429.
Article
17. Morrell F, Whisler WW, Bleck T. Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy. J Neurosurg. 1989. 70:231–239.
Article
Full Text Links
  • JKMA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr