Epilepsy is a common neurological disease impacting both patients and
healthcare systems. Approximately one third of patients have drugresistant
epilepsy (DRE) and are candidates for surgery. However, only
a small percentage undergo surgical treatment due to factors such as
patient misconception/fear of surgery, healthcare disparities in epilepsy
care, complex presurgical evaluation, primary care knowledge gap, and
lack of systemic structures to allow effective coordination between
referring physician and surgical epilepsy centers.
Resective surgical treatments are superior to medication management
for DRE patients in terms of seizure outcomes but may be less palatable
to patients. There have been major advancements in minimally
invasive surgeries (MIS) and neuromodulation techniques that may
allay these concerns. Both epilepsy MIS and neuromodulation have
shown promising seizure outcomes while minimizing complications.
Minimally invasive methods include Laser Interstitial Thermal Therapy
(LITT), RadioFrequency Ablation (RFA), Stereotactic RadioSurgery (SRS).
Neuromodulation methods, which are more palliative, include Vagus
Nerve Stimulation (VNS), Deep Brain Stimulation (DBS), and Responsive
Neurostimulation (RNS). This review will discuss the role of these
techniques in varied epilepsy subtypes, their effectiveness in improving
seizure control, and possible adverse outcomes.
Keywords: Ablation, epilepsy surgery, minimally invasive epilepsy
surgery, neuromodulation, seizure