Chopping and changing: long-term results of epilepsy surgery.

摘要

Surgical management of medically refractory focal epilepsy has seen a resurgence in the past 20 years.1 Advances in structural and functional neuroimaging2 and invasive electroencephalography have increased success in identifying the ictal onset zone; and functional MRI, tractography, and cortical mapping have allowed for safe resection. Seizure freedom is the most substantial predictor of improved quality of life, and freedom rates of 60-70% are routinely reported after 1-2 years' follow-up.3~s However, seizure control at late follow-up is less good (table) with many studies reporting seizure freedom rates of 40-50% at 10 years. Moreover, few studies show how many patients have sustained long-term seizure freedom after surgery. Importantly