Epilepsy surgery: past, present and future

Although epilepsy surgery has met with increased interest in recent years it is still underused in most countries, particularly third-world countries. Possible reasons for the recent expansion in epilepsy surgery in the so-called developed countries include the availability of advanced non-invasive diagnostic tools to delineate epileptogenic lesions and epilepsy-related functional deficits. and to prove ‘epileptogenicity’. Improved surgical techniques are, however, equally important. This translates into better postsurgical outcome figures and into a larger population of difficult-to-treat patients profiting from surgical therapy. There is, also. an important role for epilepsy surgery within the modem neuroscience field. A critical review and analysis of the present state-of-the-art epilepsy surgery is presented and possible scenarios for its future development are outlined. Within this framework the conceptual differentiation of epilepsy surgery into three categories-‘lesion-oriented surgery’, ‘epilepsy-oriented lesional surgery’ and ‘epilepsy surgery SEXISTS srr-icro’-is maintained, since it is relevant to the organization of epilepsy centres. The growing need for quality control and multidiiciplinary and worldwide collaboration is emphasized.