Epilepsy

The neurosurgeon's role in treating epilepsy has ranged from small cran-iotomies and resection of focal lesions to hemispherectomy. Large brain resection for intractable seizures has fallen out of vogue primarily because of more effective anticonvulsant medications and better electrophysiological monitoring, permitting a more precise localization of epileptiform focus. In the last decade, a relatively minimally invasive technique has gained acceptance as a viable alternative in treating epilepsy. In patients for whom monitoring cannot accurately localize a seizure focus or who have bilateral foci, with poor seizure control despite administration of multiple oral anticonvulsants, vagal nerve stimulation provides a safe and effective option. At many centers, this technique has replaced corpus collosotomy as the treatment of choice for poorly localized secondarily generalizing epilepsy. It is a safe, well-tolerated procedure that can improve the seizure frequency and severity in many patients (25).

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