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Refractory focal epilepsy causes physical, psychological, psychiatric, social, familial, and financial morbidity and a greatly increased risk of premature mortality. Resective neurosurgery brings the possibility of long-term seizure remission, but is only suitable in approximately half of the patients who undergo presurgical evaluation.1 The remaining individuals are often not suitable for ablative procedures, because a single epileptogenic zone may not be definable, or it overlaps eloquent cortex so that the risk/benefit ratio is not appealing. What further treatment can be offered to these individuals, noting that the chance of further medication changes bringing remission is less than 5%? Vagus nerve stimulation is of modest benefit, reducing seizures by 50% in 55% of patients2 and with long-term remission being exceptionally rare. What else might be offered?
Footnotes
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