Surgical treatment of medically refractory epilepsy

The last two decades have witnessed remarkable advances in the evaluation and treatment of patients with refractory epilepsy. We now understand the natural history of epilepsy and the causes of medical refractoriness better. The improvement in the localization of the seizure focus through the advances in technology such as digital EEG, structural and functional neuroimaging and stereotactic placement of invasive electrodes have facilitated the selection of ideal surgical candidates and thereby have improved postoperative outcome. A recent randomized, controlled trial confirmed that the seizure outcome is far superior in surgically-treated refractory temporal lobe epilepsy patients when compared to those continued on medical treatment. Today, surgical treatment is certainly a cost-effective option in carefully selected patients with medically refractory partial epilepsy. Developing countries should concentrate on selectively utilizing the recent advances to evolve cost-effective epilepsy surgery programs. It is encouraging to note that more neurology centers in India and other developing nations are currently developing facilities for epilepsy surgery.