Update on the surgical treatment of epilepsy
Abstract
PURPOSE OF REVIEW: Using the most recent evidence, we provide an update about epilepsy surgery, focusing on the presurgical evaluation and surgical planning, epilepsy surgery outcomes, and utilization. RECENT FINDINGS: Great strides are being achieved in the presurgical evaluation and planning for epilepsy surgery, including fundamental advances in imaging and neurophysiology. A recent randomized controlled trial demonstrates that early surgery for patients with mesial temporal lobe epilepsy (TLE) is superior to medical therapy. The enduring benefits of surgery continue to be demonstrated, particularly after TLE surgery. However, studies examining the long-term outcomes after extratemporal lobe epilepsy surgery are scarce. Surgery is generally associated with an improvement in depression, but mostly in those with good surgical outcome. Complications from invasive monitoring or after epilepsy surgery are generally temporary, or limited in their symptomatology. One area in need of prospective studies is the topic of antiepileptic drug withdrawal after epilepsy surgery (Who? When? How?). Despite its proven effectiveness, epilepsy surgery continues to be underutilized, but new tools for health professionals are emerging to guide appropriate surgical referrals. SUMMARY: Important contributions to the field of epilepsy surgery are discussed, in particular emerging imaging (fMRI) and neurophysiological (high-frequency oscillations) techniques. Epilepsy surgery is effective, well tolerated but still underutilized.
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There are no effective treatments or preventive/disease-modifying therapies for TLE or epileptogenesis.
“Aside from neurosurgical resection, which benefits only a small population of TLE patients [2], there are no other effective treatments or preventive strategies for TLE [3].”
From Hippocampal neuro-networks and dendritic spine perturbations in epileptogenesis are attenuated by neuroprotectin D1 (2015) · cites this paper as [2]
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Lenge, M., Fiori, S., Cappelletto, P., Droghini, A., Barbi, E., Buccoliero, A. M., Donatelli, G., Tosetti, M., Giordano, F., Barba, C., et al. (2026) · Neuroradiology · doi:10.1007/s00234-026-04103-8 · Cited by 1 · see citing works
Human–artificial intelligence collaboration for comanaging epilepsy in real time
Goldblum, Z., Shi, H., Xu, Z., Ojemann, W. K. S., Aguila, C. A., Long, K. W., Xie, K., Nix, K. C., Walsh, K. G., Chang, E., et al. (2026) · Nature Medicine · doi:10.1038/s41591-026-04680-4 · Cited by 5 · see citing works
Neuromodulation for the Treatment of Drug-Resistant Epilepsy
Romanelli, P., & Conti, A. (2014) · Contemporary clinical neuroscience · doi:10.1007/978-3-319-12283-0_12 · Cited by 1 · see citing works
Responsive Stimulation in the Management of Medically Refractory Epilepsy
McGovern, R. A., Banks, G. P., & McKhann, G. M. (2018) · Springer eBooks · doi:10.1007/978-3-319-95918-4_19 · Cited by 1 · see citing works
Sánchez, A. M. G., & Orejuela-Zapata, J. F. (2018) · Radiología (English Edition) · doi:10.1016/j.rxeng.2018.07.003 · Cited by 1 · see citing works
Präoperative Epilepsiediagnostik und Epilepsiechirurgie
Baumgartner, C., & Pataraia, E. (2001) · Springer eBooks · doi:10.1007/978-3-7091-6250-7_16 · Cited by 1 · see citing works
Jain, M. (2016) · Journal of Medical Science And clinical Research · doi:10.18535/jmscr/v4i5.33
Mathon, B., Baulac, M., Dupont, S., Navarro, V., Carpentier, A. C., Cornu, P., & Clémenceau, S. (2014)
Voxel-based morphometry analysis of subcortical structures in unilateral Mesial Temporal Sclerosis
Orejuela-Zapata, J. F. (2017) · European Society of Radiology · doi:10.1594/ecr2018/c-0111
Current and Future Perspectives of Epilepsy Surgery in Japan
Iwasaki, M., Iijima, K., Takayama, Y., Kimura, Y., & Kaneko, Y. (2019) · Japanese Journal of Neurosurgery · doi:10.7887/jcns.28.326
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Chemical Exchange Saturation Transfer for Epilepsy Imaging
Brown, J. D., Kim, H., Sun, P. Z., & Hu, R. (2024) · Applied Radiology · doi:10.37549/ar2981
- Authors
- Jette, N., & Wiebe, S.
- Affiliations
- University of Calgary (CA)
- Corresponding author
- Wiebe, Samuel
- ORCID
- Wiebe, Samuel
- Venue
- Current Opinion in Neurology
- Published
- 2013-04
- Volume
- 26
- Issue
- 2
- Pages
- 201-207
- ISSN
- 1350-7540 (ISSN-L)
- OpenAlex
- W2322065534
- Cited by
- 56
- References
- 43
- Citations by year
- 2026: 4 · 2024: 5 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 9 · 2014: 8 · 2013: 3
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Neurology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Keywords
- epilepsy surgery, preoperative assessment, surgical planning, mesial temporal lobe epilepsy, extratemporal epilepsy, postoperative outcomes, depression, postoperative complications, invasive monitoring, antiepileptic drug withdrawal, functional MRI, high-frequency oscillations, surgical referral
- MeSH terms
- Epilepsy, Humans, Neurosurgery
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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