Beyond pharmacotherapy: surgical management

Details

Serval ID
serval:BIB_EB88CDF966B3
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Beyond pharmacotherapy: surgical management
Journal
Epilepsia
Author(s)
Ryvlin P.
ISSN
0013-9580 (Print)
ISSN-L
0013-9580
Publication state
Published
Issued date
2003
Volume
44 Suppl 5
Pages
23-8
Language
english
Notes
Ryvlin, Philippe
eng
Epilepsia. 2003;44 Suppl 5:23-8.
Abstract
PURPOSE: To review the recent advances in the field of temporal lobe epilepsy (TLE) surgery. RESULTS: TLE surgery has recently demonstrated a highly significant superiority over optimal medical therapy in a randomized trial. Accordingly, a median rate of 70% of class I outcome (patients free of disabling seizures postoperatively) has emerged from the pooling of all data published since the early 1990s. In addition, successful TLE surgery appears likely to reduce the risk of seizure-related death. However, it remains largely underused and overly delayed, partly because of the legitimate fears of possible surgical complications, such as verbal memory deficits or failure to control seizures. Reasons for surgical failures are not completely understood, and include bitemporal, pseudotemporal, and temporal-plus epilepsies, as well as insufficient resection of the mesial temporal structures. Developing techniques such as intraoperative MRI, gamma-knife radiosurgery, and various types of cranial nerves or intracerebral chronic stimulation have the potential to alleviate part of the limitations of TLE surgery. CONCLUSIONS: The overall benefit of surgical treatment in patients with drug-resistant TLE should encourage a more frequent and earlier referral of such patients to epilepsy surgery centers. Important progress toward higher rates of seizure-free outcome and lower morbidity remains to be made and may be obtained by taking advantage of the new available technologies.
Keywords
Anterior Temporal Lobectomy/*methods, Anticonvulsants/therapeutic use, Drug Resistance, Electric Stimulation Therapy/methods, Epilepsy, Temporal Lobe/diagnosis/mortality/*surgery, Humans, Image Processing, Computer-Assisted, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Quality of Life, Radiosurgery/methods, Randomized Controlled Trials as Topic, Survival Rate, Treatment Outcome
Pubmed
Create date
29/11/2018 12:37
Last modification date
20/08/2019 16:13
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