title: Epilepsy surgery: recommendations for India.
abstract: The following article recommends guidelines for epilepsy surgery for India. This article reviews the indications, the various surgical options available and the outcome of surgery for drug resistant epilepsy based on current evidence. Epilepsy surgery is a well-established option for patients who have been diagnosed to have drug resistant epilepsy (DRE) (on at least two appropriate, adequate anti-epileptic drugs (AEDs) (either in monotherapy or in combination) with continuing seizures), where the presurgical work-up has shown concordance of structural imaging (magnetic resonance imaging) and electrical mapping data (electroencephalography (EEG), video EEG). There may be a requirement of functional imaging techniques in a certain number of DRE like positron emission tomography (PET), single photon emission tomography, (SPECT)). Invasive monitoring should be restricted to a few when all noninvasive investigations are inconclusive, there is a dual pathology or there is a discordance of noninvasive data. The types of surgery could be curative (resective surgeries: amygdalo hippocampectomy, lesionectomy and multilobar resections; functional surgeries: hemispherotomy) and palliative (multiple subpial transaction, corpus callosotomy, vagal nerve stimulation). Epilepsy surgery in indicated cases has a success range from 50 to 86% in achieving seizure freedom as compared with <5% success rate with AEDs only in persons with DRE. Centers performing surgery should be categorized into Level I and Level II.
authors.affiliation: Department of Neurosurgery New Delhi-110 029, India. saratpchandra@gmail.com
authors.forename: P Sarat
authors.initials: PS
authors.lastname: Chandra
authors.forename: Manjari
authors.initials: M
authors.lastname: Tripathi
references.citation: Neurol India. 1999 Sep;47(3):196-201
references.pmid: 10514578
references.citation: Neurol India. 2008 Apr-Jun;56(2):127-32
references.pmid: 18688135
references.citation: N Engl J Med. 2001 Aug 2;345(5):311-8
references.pmid: 11484687
references.citation: Arch Neurol. 2001 Apr;58(4):678-80
references.pmid: 11296007
references.citation: Epilepsia. 2006 Sep;47(9):1543-9
references.pmid: 16981871
references.citation: Epilepsia. 2010 Jun;51(6):1097-100
references.pmid: 20345935
references.citation: Brain. 2006 Mar;129(Pt 3):617-24
references.pmid: 16401617
references.citation: Epilepsy Behav. 2005 Mar;6(2):147-55
references.pmid: 15710297
references.citation: Neurol India. 2007 Oct-Dec;55(4):343-8
references.pmid: 18040106
references.citation: Neurology. 2003 Feb 25;60(4):538-47
references.pmid: 12601090
references.citation: Epilepsia. 2010 Jun;51(6):1069-77
references.pmid: 19889013
references.citation: Neurol India. 2005 Jun;53(2):156-60; discussion 160-1
references.pmid: 16010051
references.citation: Neurology. 2005 Sep 27;65(6):912-8
references.pmid: 16186534
references.citation: Brain. 2001 Sep;124(Pt 9):1683-700
references.pmid: 11522572
references.citation: Pediatr Neurol. 2005 Sep;33(3):173-8
references.pmid: 16139731
references.citation: Ann Neurol. 2007 Oct;62(4):327-34
references.pmid: 17567854
references.citation: Epilepsia. 2005;46 Suppl 1:46-7
references.pmid: 15868687
references.citation: N Engl J Med. 1996 Mar 7;334(10):647-52
references.pmid: 8592530
references.citation: Seizure. 2000 Oct;9(7):464-8
references.pmid: 11034869
references.citation: Epilepsy Res. 2010 Mar;89(1):133-41
references.pmid: 20079611
references.citation: Lancet Neurol. 2002 Oct;1(6):375-82
references.pmid: 12849399
references.citation: Semin Neurol. 2002 Sep;22(3):269-78
references.pmid: 12528052
references.citation: Epilepsy Res. 2003 Feb;53(1-2):139-50
references.pmid: 12576175
references.citation: Epilepsia. 1991 May-Jun;32(3):335-40
references.pmid: 2044496
references.citation: Neurol India. 2008 Apr-Jun;56(2):138-43
references.pmid: 18688137
references.citation: Epilepsia. 2004 Jul;45(7):803-8
references.pmid: 15230705
references.citation: J Neurol Neurosurg Psychiatry. 2002 Dec;73(6):643-7
references.pmid: 12438463
references.citation: J Neurol Neurosurg Psychiatry. 2001 Nov;71(5):632-7
references.pmid: 11606675
references.citation: Neurol India. 2006 Jun;54(2):144-50; discussion 150-1
references.pmid: 16804257
references.citation: N Engl J Med. 2000 Feb 3;342(5):314-9
references.pmid: 10660394