Advances in surgical options for medically refractory epilepsy

The evolution of surgical treatment for medically refractory epilepsy (MRE) has been influenced over the last decade by substantial advancements in imaging- and device-related technology, as well as an expanding assemblage of prospective data that support the utilisation of surgery for MRE. These data, which have grown to include randomised trials and long-term follow up for established surgery, as well as large series for investigational procedures, have demonstrated safe, efficacious results with proper patient selection. Prospective randomised trials of three surgically implanted neuromodulatory devices, vagus nerve stimulators, deep brain stimulators and responsive neurostimulators have demonstrated safety and significant seizure frequency reduction. Numerous studies have provided strong evidence for the efficacy and safety of temporal lobe resective surgery and recent studies have focused on applying alternative approaches to open resective surgery for patients presumed to have a medial temporal seizure focus. These alternatives include stereotactic radiosurgery, radiofrequency ablation and a magnetic resonance imaging (MRI)-guided laser technique for thermal ablation. Current evidence for these new surgical options for the treatment of medically refractory epilepsy will be presented and discussed.