Epilepsy surgery

Pract Neurol. 2020 Feb;20(1):4-14. doi: 10.1136/practneurol-2019-002192. Epub 2019 Aug 16.


Epilepsy surgery offers the chance of seizure remission for the 30%-40% of patients with focal epilepsy whose seizures continue despite anti-epileptic medications. Epilepsy surgery encompasses curative resective procedures, palliative techniques such as corpus callosotomy and implantation of stimulation devices. Pre-surgical evaluation aims to identify the epileptogenic zone and to prevent post-operative neurological and cognitive deficits. This entails optimal imaging, prolonged video-electroencephalogram (EEG) recordings, and neuropsychological and psychiatric assessments; some patients may then require nuclear medicine imaging and intracranial EEG recording. The best outcomes are in those with an electro-clinically concordant structural lesion on MRI (60%-70% seizure freedom). Lower rates of seizure freedom are expected in people with extra-temporal lobe foci, focal-to-bilateral tonic-clonic seizures, normal structural imaging, psychiatric co-morbidity and learning disability. Nevertheless, surgery for epilepsy is under-used and should be considered for all patients with refractory focal epilepsy in whom two or three anti-epileptic medications have been ineffective.

Keywords: epilepsy; epilepsy surgery.

Publication types

  • Review

MeSH terms

  • Anticonvulsants / therapeutic use
  • Drug Resistant Epilepsy / diagnostic imaging
  • Drug Resistant Epilepsy / drug therapy
  • Drug Resistant Epilepsy / surgery*
  • Electroencephalography / methods
  • Epilepsies, Partial / diagnostic imaging
  • Epilepsies, Partial / drug therapy
  • Epilepsies, Partial / surgery*
  • Humans
  • Intraoperative Neurophysiological Monitoring / methods*
  • Preoperative Care / methods*
  • Seizures / diagnostic imaging
  • Seizures / drug therapy
  • Seizures / surgery*
  • Stereotaxic Techniques


  • Anticonvulsants