Optimising epilepsy surgery

About a third of individuals with epilepsy do not have their seizures controlled by medication, comprising roughly 20 million people worldwide. Neurosurgical treatment can be curative for those who have focal epilepsy. In the most favourable circumstances, more than 80% of individuals with focal epilepsy who undergo surgery can be seizure-free for around a year. Over a period of 20 years, approximately 40% of patients who are treated with surgery can remain seizure-free. 1 Bell GS de Tisi J Gonzalez-Fraile JC et al. Factors affecting seizure outcome after epilepsy surgery: an observational series. J Neurol Neurosurg Psychiatry. 2017; 88: 933-940 Crossref PubMed Scopus (46) Google Scholar , 2 McIntosh AM Wynd AW Berkovic SF Extended follow-up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery. Epilepsia. 2023; 64: 92-102 Crossref PubMed Scopus (2) Google Scholar Clinical features can predict the likelihood of seizure freedom after surgery. A factor that can predict a positive outcome is the presence of a focal lesion on MRI that is concordant with clinical and EEG data. Predictors that might indicate a negative outcome include an unremarkable MRI, extratemporal epilepsy, focal to bilateral tonic–clonic seizures, a long duration of epilepsy, learning disability, and psychiatric comorbidity. 1 Bell GS de Tisi J Gonzalez-Fraile JC et al. Factors affecting seizure outcome after epilepsy surgery: an observational series. J Neurol Neurosurg Psychiatry. 2017; 88: 933-940 Crossref PubMed Scopus (46) Google Scholar , 3 Jehi L Yardi R Chagin K et al. Development and validation of nomograms to provide individualised predictions of seizure outcomes after epilepsy surgery: a retrospective analysis. Lancet Neurol. 2015; 14: 283-290 Summary Full Text Full Text PDF PubMed Scopus (150) Google Scholar Personalised virtual brain models in epilepsyIndividuals with drug-resistant focal epilepsy are candidates for surgical treatment as a curative option. Before surgery can take place, the patient must have a presurgical evaluation to establish whether and how surgical treatment might stop their seizures without causing neurological deficits. Virtual brains are a new digital modelling technology that map the brain network of a person with epilepsy, using data derived from MRI. This technique produces a computer simulation of seizures and brain imaging signals, such as those that would be recorded with intracranial EEG. Full-Text PDF Correction to Lancet Neurol 2023; 22: 373–74Duncan JS, Taylor PN. Optimising epilepsy surgery. Lancet Neurol 2023; 22: 373–74—In this Comment, the authors’ declaration of interests statements were missing; the full declarations are now included. This correction has been made to the online version as of May 18, 2023. Full-Text PDF