Since the late 19th century, surgery has been accepted as a treatment for medically refractory epilepsy. Although a multicenter, randomized trial has not been performed, published data from individual centers and pooled data from the University of California Los Angeles (UCLA) Palm Desert Conference held in 1992 show that surgery for seizures results in seizure-free outcome in most patients with hippocampal sclerosis or a well-defined lesion.
Overview of seizure-based outcome classification systems
When looking at the efficacy of epilepsy surgery, a patient’s postsurgical seizure frequency is compared with his or her preoperative seizure frequency. Usually, these assessments are performed at individual centers where the number of patients is small and patients serve as their own controls. In doing so, the assumption is made, based on the natural history of intractable epilepsy, that spontaneous remissions without surgery are infrequent. We now know from the work of Berg et al that prolonged remissions can occur before eventual intractability becomes evident.
Go to Epilepsy and Seizures, Neuroimaging in Epilepsy, Presurgical Evaluation of Medically Intractable Epilepsy, and Epilepsy Surgery for complete information on these topics.