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Chapter 22 - Surgical Therapies for Epilepsy

Published online by Cambridge University Press:  11 October 2019

By
Rushna Ali  and
Ellen L. Air
Edited by
Vibhangini S. Wasade  and
Marianna V. Spanaki
Vibhangini S. Wasade
Affiliation:
Henry Ford Medical Group HFHS, Michigan
Marianna V. Spanaki
Affiliation:
Wayne State University, Michigan
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Summary

The International League Against Epilepsy (ILAE) put forth the definition for intractable epilepsy as the persistence of seizures despite “adequate trials of two tolerated, appropriately chosen and used antiseizure drug [ASD] schedules (whether as monotherapies or in combination).”1 The definition of medically refractory epilepsy has been debated for many years,2 and expert opinion remains divergent from common practice.3 It has been well-documented that the chances of achieving seizure freedom are minimal with additional trials of ASDs and that increased duration of seizures before surgery is associated with decreased chance of long-term seizure freedom.4 The American Association of Neurology 2015 Epilepsy Quality Measures recommend that each patient should have their diagnosis and treatment plan evaluated, and a referral for presurgical evaluation should be considered to a level 4 epilepsy center for those who are medically refractory about once every 2 years.5 As part of this referral and reassessment, surgery should be considered.

Type
Chapter
Information
Understanding Epilepsy
A Study Guide for the Boards
 , pp. 417 - 431
Publisher: Cambridge University Press
Print publication year: 2019

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References

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