Complex Partial Seizures: Surgical Treatment.
Any patient who continues to have complex partial seizures following an adequate trial of antiepileptic drugs (AEDs) should be considered for evaluation for surgery in a comprehensive epilepsy center. Investigations should include 24-hour electroencephalographic (EEG) monitoring, a high-resolution magnetic resonance imaging (MRI) study, and neuropsychological assessment. Surgery is most effective in patients with unilateral hippocampal atrophy or a structural lesion and concordant EEG findings. With modern microsurgical techniques, surgery is associated with a low rate of major morbidity. The vagal nerve stimulator is a device recently approved by the United States Food and Drug Administration that may offer control equivalent to that of AEDs in patients who are not candidates for surgical resection.
Baltuch
GH
Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., 5 Silverstein, Philadelphia, PA 19104, USA.