Patients with partial epilepsy who are considered for surgery have difficult-to-control seizures that have not responded to aggressive treatment with medication. In the past, patients usually tried several medications with poor results for many years, even decades, before being considered for surgery. But more recently, surgery is considered sooner because studies have shown that the earlier surgery is performed, the better the outcome. A person who has been given several seizure medicines in adequate dosages and for a long enough period without a good response is unlikely to achieve complete seizure control with another kind of medicine. Surgery is now being performed on some patients whose seizures have been uncontrolled for only 1 or 2 years. At least two single drugs and a combination of two or more drugs should be tried before surgery is considered.

Epilepsy surgery can be especially beneficial to patients who have seizures associated with structural brain abnormalities, such as benign brain tumors, malformations of blood vessels (including disorders known as arteriovenous malformations, venous angiomas, and cavernous angiomas), and strokes.

Epilepsy treatment has evolved to include consideration of the patient's quality of life, not just the number of seizures. Both continued seizures and high doses of medication impose costs on all areas of a person's life—intellectual, psychological, social, educational, and employment. The individualized approach that should be used when prescribing seizure medicines is carried over to the surgical treatment of epilepsy. State-of-the-art technology is applied to perform the safest and least-invasive procedure that will help the patient to achieve the highest possible quality of life.

Topic Editor: Howard L. Weiner, M.D.

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