Epilepsy is one of the most common neurological disorders. Nearly all patients with recurrent seizures receive medical management, and many respond well, but seizures in more than one-quarter of patients are not adequately controlled, and patients suffer long-term morbidity, disability, and underemployment as a consequence. Neurosurgical intervention is the best treatment for many of these medically intractable patients.
Over the past 50 years, neurosurgical treatment of epilepsy has become progressively more sophisticated, and more widely available, so that there are now hundreds of specialized epilepsy surgery centers around the world, as well as a broad consensus on the fundamentals of selecting surgical candidates, performing the presurgical evaluation, and techniques of the surgical resection. Although several very excellent and comprehensive books on epilepsy surgery exist, this book takes a different approach. In addition to presenting the current state of the art, we highlight the evolving and unresolved questions in epilepsy surgery, and in this way bring out the limitations of current techniques and future directions the field must take.
Significant controversies exist regarding almost every aspect of epilepsy surgery. Human epilepsy is an extraordinarily diverse condition. It has many underlying etiologies, with seizures arising from many different regions of the brain. The presurgical workup aims to determine the site of origin of a patient’s seizures (‘‘the epileptogenic zone’’), and to determine if that region can be safely removed without injury to brain regions that mediate key neurological functions (‘‘essential cortex’’). The methods we have to do this are imperfect, and a successful outcome is not assured. Because of this, epilepsy surgery is constantly evolving, with new technology to better locate the epileptogenic zone and essential cortices being continually introduced or perfected, and new surgical approaches being developed to improve outcome and make neurosurgical treatment available to more patients.
In addition, there have been few definitive clinical trials of neurosurgical therapies. Acontrolled, randomized study of temporal lobectomy has been performed and confirms the superiority of surgery over continued medication trials in these intractable patients. The unfavorable natural history of intractable epilepsy has been well characterized, and the benefits of surgery in optimal candidates are so dramatic that these findings are not surprising. However, many other questions, for example, the relative merits of the standard temporal lobectomy and the selective amygdalohippocampectomy, involve much smaller alleged outcomedifferences and cry out for randomized studies.As this text will make evident, clinical trials of surgical therapy are extraordinarily difficult to design and execute, and Class I evidence has rarely been obtained. As a result, ongoing controversy will continue to be inherent to the field.
The backbone of the book is a series of reviews of steps in the comprehensive process of epilepsy surgery, from selection of surgical candidates to the presurgical workup through techniques of the resection itself, assessment of outcome, and on to postoperative rehabilitation and vocational training. Each section is followed by a series of essays on controversies regarding many of the topics reviewed. Diverse opinions were solicited from experts who have published on the contested topic. Sometimes these editorial chapters present starkly divergent viewpoints; more often they are parallel and converge from different viewpoints to find common ground. These chapters represent current opinion as of 2005 but will continue to evolve after publication. The book ends with a section on investigational techniques and therapies.
The heart of every comprehensive epilepsy surgery program lies in the multidisciplinary case conference where neurologists, neurosurgeons, neuropsychologists, neuroradiologists, rehabilitation specialists, and others collaborate to make surgical decisions. Each specialty contributes its own skills and insights to the meeting to develop an understanding of the significance and limitations of the presurgical data and predict the chances of seizure control with the proposed procedure and the implications of the probable outcome for an individual’s life. The complexity of this process arises not only from the controversies inherent to the subject, but also from the diversity and heterogeneity of human epilepsy. Frank and lively discussions often lead to the realization and acknowledgment of the limitations of both diagnostic methods and the scientific evidence upon which surgical decisions are made. Often, new investigations and clinical trials result from these debates. This text was inspired by this intellectual excitement of the epilepsy surgery conference. It will bring new insights to all who treat epilepsy.
Book features:
Over the past 50 years, neurosurgical treatment of epilepsy has become progressively more sophisticated, and more widely available, so that there are now hundreds of specialized epilepsy surgery centers around the world, as well as a broad consensus on the fundamentals of selecting surgical candidates, performing the presurgical evaluation, and techniques of the surgical resection. Although several very excellent and comprehensive books on epilepsy surgery exist, this book takes a different approach. In addition to presenting the current state of the art, we highlight the evolving and unresolved questions in epilepsy surgery, and in this way bring out the limitations of current techniques and future directions the field must take.
Significant controversies exist regarding almost every aspect of epilepsy surgery. Human epilepsy is an extraordinarily diverse condition. It has many underlying etiologies, with seizures arising from many different regions of the brain. The presurgical workup aims to determine the site of origin of a patient’s seizures (‘‘the epileptogenic zone’’), and to determine if that region can be safely removed without injury to brain regions that mediate key neurological functions (‘‘essential cortex’’). The methods we have to do this are imperfect, and a successful outcome is not assured. Because of this, epilepsy surgery is constantly evolving, with new technology to better locate the epileptogenic zone and essential cortices being continually introduced or perfected, and new surgical approaches being developed to improve outcome and make neurosurgical treatment available to more patients.
In addition, there have been few definitive clinical trials of neurosurgical therapies. Acontrolled, randomized study of temporal lobectomy has been performed and confirms the superiority of surgery over continued medication trials in these intractable patients. The unfavorable natural history of intractable epilepsy has been well characterized, and the benefits of surgery in optimal candidates are so dramatic that these findings are not surprising. However, many other questions, for example, the relative merits of the standard temporal lobectomy and the selective amygdalohippocampectomy, involve much smaller alleged outcomedifferences and cry out for randomized studies.As this text will make evident, clinical trials of surgical therapy are extraordinarily difficult to design and execute, and Class I evidence has rarely been obtained. As a result, ongoing controversy will continue to be inherent to the field.
The backbone of the book is a series of reviews of steps in the comprehensive process of epilepsy surgery, from selection of surgical candidates to the presurgical workup through techniques of the resection itself, assessment of outcome, and on to postoperative rehabilitation and vocational training. Each section is followed by a series of essays on controversies regarding many of the topics reviewed. Diverse opinions were solicited from experts who have published on the contested topic. Sometimes these editorial chapters present starkly divergent viewpoints; more often they are parallel and converge from different viewpoints to find common ground. These chapters represent current opinion as of 2005 but will continue to evolve after publication. The book ends with a section on investigational techniques and therapies.
The heart of every comprehensive epilepsy surgery program lies in the multidisciplinary case conference where neurologists, neurosurgeons, neuropsychologists, neuroradiologists, rehabilitation specialists, and others collaborate to make surgical decisions. Each specialty contributes its own skills and insights to the meeting to develop an understanding of the significance and limitations of the presurgical data and predict the chances of seizure control with the proposed procedure and the implications of the probable outcome for an individual’s life. The complexity of this process arises not only from the controversies inherent to the subject, but also from the diversity and heterogeneity of human epilepsy. Frank and lively discussions often lead to the realization and acknowledgment of the limitations of both diagnostic methods and the scientific evidence upon which surgical decisions are made. Often, new investigations and clinical trials result from these debates. This text was inspired by this intellectual excitement of the epilepsy surgery conference. It will bring new insights to all who treat epilepsy.
Book features:
- Weighing recent debates related to one of the most common neurological disorders, this guide contains opinions and recommendations from well-known specialists in the field.
- Discusses the multidisciplinary principles used to select and evaluate surgical candidates.
- Reviews steps in the comprehensive process of epilepsy surgery.
- outlines the assessment, surgical, and psychosocial outcomes, and the scientific evidence demonstrating the efficacy of different surgical procedures.
- provides a section devoted purely to investigational techniques and therapies for up-to-date coverage of emerging treatment options.
- Hardcover: 880 pages
- Publisher: Informa HealthCare; 1 edition
- Language: English
- ISBN-10: 0824725913
- ISBN-13: 9780824725914