British Society for Clinical Neurophysiology promote and encourage for the public benefit the science and practice of clinical neurophysiology and related sciences

Lecture Details

Epilepsy surgery – a clinical neurologist’s perspective
Dr Udo Weismann

Consultant Neurologist, The Walton Centre  for Neurology and Neurosurgery, Liverpool

Epilepsy surgery - a clinical neurologist’s perspective
Until relatively recently a surprising number of different and bizarre surgical procedures have been performed in patients with epilepsy including colectomy to eliminate the “bacillus epilepticus”, cerebral venous sinus surgery and transplantation of the greater omentum into the skull.These are now considered to be obsolete and have been replaced by cortical resections. Magnetic resonance imaging (MRI) has revolutionised the pre-surgical work up of patients with medically refractory epilepsy. MRI has in rendered the use of invasive EEG, in particular with foramen ovale electrodes, superfluous in many cases. MRI is a very versatile tool. In animal experiments MRI can detect diffusion changes associated with seizures. However, so far MRI has failed to replace EEG as a functional diagnostic tool in humans. Unfortunately, epilepsy surgery is by no means always effective. In the long-term less than half of all patients undergoing resective epilepsy surgery remain seizure free. For many patients epilepsy surgery merely converts a medically refractory epilepsy to a more medically treatable form. Despite an improved pre-surgical work up with MRI the outcomes of epilepsy surgery in the modern era are broadly comparable to the outcomes in the pre MRI era. There has been a renaissance of stereo EEG (sEEG). SEEG was pioneered by Talairach and Bancaud who were well aware of the limitations of sEEG, in particular in frontal lobe epilepsy. Any overoptimistic claims should be regarded with suspicion. A plausible explanation for seizure recurrence after resective brain surgery is that the surgery itself is potentially epileptogenic. Deep brain stimulation (DBS) as a treatment for epilepsy has been overall disappointing. However, occasionally DBS may be helpful. This is illustrated in a patient who underwent DBS at Walton