title: [Evolution of ideas and techniques, and future prospects in epilepsy surgery].
abstract: BACKGROUND
  The aim of this article was to review and evaluate the published literature related to the outcome of epilepsy surgery, while placing it in an historical perspective, and to describe the future prospects in this field.
  
  
  BACKGROUND
  Temporal lobe surgery achieves seizure freedom in about 70% of cases. Seizure outcome is similar in the pediatric population. Extratemporal resections impart good results to 40% to 60% of patients, with a better prognosis in the case of frontal lobe surgery. Pediatric hemispherotomy leads to seizure control in about 80% of children. Radiosurgery used as a treatment for temporal mesial epilepsy has an outcome quite similar to that obtained with surgical resection, but provides a neuropsychological advantage. Radiosurgery is also effective in 60% of children treated for seizures related to hypothalamic hamartoma. Regarding palliative surgery, callosotomy and multiple subpial transections show satisfactory outcomes in over 60% of cases. Neuromodulation techniques (vagus nerve stimulation and bilateral stimulation of the anterior nucleus of the thalamus) allow a 50% reduction of seizures in half of patients.
  
  
  CONCLUSIONS
  Transcranial magnetic stimulation combined with electroencephalography seems a promising technique because of its diagnostic, prognostic and therapeutic applications. Transcranial ultrasound stimulation, which can reversibly control neuronal activity, is also under consideration. Concerning neuromodulation, trigeminal nerve stimulation may become an alternative to vagus nerve stimulation; while other targets of deep brain stimulation are being evaluated. Also, the possibility of coupling SEEG seizure focus detection with concomitant laser or radiofrequency focus destruction is under development.
  
  
  CONCLUSIONS
  Constant evolution of epilepsy surgery has improved patient outcomes over time. Current research and development axes suggest the continuation of this trend and a reduction of the invasiveness of surgical procedures.
authors.affiliation: Department of neurosurgery, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: bertrand.mathon@neurochirurgie.fr.
authors.forename: B
authors.initials: B
authors.lastname: Mathon
authors.affiliation: Department of epileptology, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Bédos-Ulvin
authors.affiliation: Department of epileptology, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Baulac
authors.affiliation: Department of epileptology, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dupont
authors.affiliation: Department of epileptology, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Navarro
authors.affiliation: Department of neurosurgery, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Carpentier
authors.affiliation: Department of neurosurgery, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Cornu
authors.affiliation: Department of neurosurgery, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Clemenceau
mesh_terms: D035843:Biomedical Research / Q000639:trends*; D002648:Child; D046690:Deep Brain Stimulation; D004827:Epilepsy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006222:Hamartoma / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends*; D016634:Radiosurgery / Q000706:statistics & numerical data; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome
keywords: Axes de recherche; Chirurgie; Clinical course; Epilepsy; Histoire; History; Outcome; Research axes; Review; Revue; Résultats; Surgery; Épilepsie; Évolution