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Functional operations modify the pathophysiology of epilepsy and they are less frequent and less effective than resective operations, but they offer some relief to a group of patients who would otherwise be untreated. Stereotactic lesioning for epilepsy has been largely unproductive. Cerebellar stimulation has fallen into disuse, having been shown to be ineffective, and vagus nerve stimulation (VNS), first described in 1990, is now a recognized technique. Recently, deep brain stimulation has been described in the thalamus and proposed in the sub-thalamic nucleus. Callosotomy was introduced in 1940 and has proved useful, as has multiple sub-pial transection, introduced by Morrell and his colleagues.

The essence of a successful epilepsy surgery program is first to identify a focus of the seizure disorder and then to establish the safety of resecting the focus. Many different strategies for achieving these aims have been used.

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