Patients with epilepsy for whom med...

Patients with epilepsy for whom medical management has failed, may be candidates for surgical treatment. Zimmerman and Sirven review the part of surgery in the treatment of seizure disorders. The persistence of seizures after three trials of different antiepileptic physics has been used to define medically intractable seizures. However, no consensus definition exists, and a certain studies indicate that refractory patients might be identified earlier.

The neighborhood of epilepsy should be confirmed and the seizure prototype defined, because some disorders are not amenable to surgical correction. Patients are evaluated based forward the seizure type and oftenness the amount and type of medical therapy, and the psychologic and social factors affected according to epilepsy. Other considerations include seizures resulting in impaired consciousness, injury, abnormal behaviors, or unpleasant auras. Patients with haunt (at least once every single in kind to two months) or unpredictable seizures also are potential candidates.

Antiepileptic medications do not completely restrain seizures in 30 to 40 percent of patients. Other reasons besides real intractability include pseudoseizures, inappropriate medications, medication noncompliance, or unreliable history. Newer agents and devices have not further proved to be effective when conventional remedys have failed. Combination therapy ofttimes is tried before surgery, although it also has not prov to induce remission when single agents have failed.

Surgery is mostly commonly performed for mesial temporal lobe epilepsy, frontal lobe epilepsy, and epilepsy secondary to a lesion. Techniques may include resection of lobe sections (eg anterior temporal lobectomy) or lesions caused from tumors, vascular malformations, or encephalomalacia. Focal tailored resection or awake craniotomy also are options. Corpus callosotomy is sometimes used when the focus is in functional brain tissue or if seizures are nonfocal. However, this technique is typically merely palliative.

Successful epilepsy surgery has l to improved quality of life and decreased mortality rates. issues vary depending on the emblem of procedure performed and the impressed sign of epilepsy being treated. Accordingly, overall rates of seizure method of treatment run as high as 70 percent and as subdued as 40 percent. Complication rates hang on the surgical team. Patients should be informed about the succes rate and complications before proceeding with surgery

Zimmerman R Sirven JI. An overview of surgery for chronic seizures. Mayo Clin Proc January 2003;78:109-17

toss CARTER, M.D. Medical Editing equal Georgetown University medical Center

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group