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Selection of Surgical Candidates

Last Updated: July 25, 2019


Medical management with anti-epileptic drugs (AEDs) is the first-line intervention for patients with epilepsy. However, 30-40% of patients have seizures that cannot be adequately controlled by AEDs.1 Drug-resistant epilepsy (DRE) is diagnosed when seizures persist after two or more appropriate AED trials.2 DRE is associated with impaired quality of life as well as higher rates of depression, anxiety, suicidality, and long-term mortality.3,4 As a group, patients with DRE account for ~80% of all epilepsy-related costs in the US.5,6

Surgical resection of the epileptogenic zone is the most effective treatment option for controlling seizures and improving life quality in patients with DRE.7 Several randomized controlled trials (RCTs) and meta-analyses demonstrate that epilepsy surgery offers the best chance of seizure control when ≥2 AED trials have failed.8-11 Although postsurgical seizure freedom rates vary with many patient factors, approximately 40-80% of patients with DRE who undergo epilepsy surgery enjoy sustained seizure relief compared to <10% of those receiving continued AED therapy.12-14

Prior to epilepsy surgery, patients undergo a comprehensive assessment to determine their surgical candidacy and to plan the intervention. Th...