Editing Epilepsy (section)

===Surgery===
[[Epilepsy surgery]] is an important treatment option for individuals with [[Management of drug-resistant epilepsy|drug-resistant epilepsy]],<ref name="pmid19800848" /><ref name="Engel2018">{{Cite journal |last=Engel |first=Jerome |date=2018 |title=The current place of epilepsy surgery |url=https://pubmed.ncbi.nlm.nih.gov/29278548 |journal=Current Opinion in Neurology |volume=31 |issue=2 |pages=192–197 |doi=10.1097/WCO.0000000000000528 |issn=1473-6551 |pmc=6009838 |pmid=29278548}}</ref> typically defined as the failure of at least two appropriately chosen and tolerated antiseizure medications.<ref>{{Cite journal |last=Kwan |first=P. |last2=Brodie |first2=M. J. |date=2000-02-03 |title=Early identification of refractory epilepsy |url=https://pubmed.ncbi.nlm.nih.gov/10660394 |journal=The New England Journal of Medicine |volume=342 |issue=5 |pages=314–319 |doi=10.1056/NEJM200002033420503 |issn=0028-4793 |pmid=10660394}}</ref> Surgery is most effective in cases of focal epilepsy, where seizures originate from a specific area of the brain that can be safely removed.<ref name="pmid7361318">{{cite journal |vauthors=Benoit PW, Yagiela A, Fort NF |date=February 1980 |title=Pharmacologic correlation between local anesthetic-induced myotoxicity and disturbances of intracellular calcium distribution |journal=Toxicology and Applied Pharmacology |volume=52 |issue=2 |pages=187–198 |bibcode=1980ToxAP..52..187B |doi=10.1016/0041-008x(80)90105-2 |pmid=7361318}}</ref><ref name="pmid28994113">{{cite journal |vauthors=Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, Englot DJ |date=December 2017 |title=Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review |journal=Epilepsia |volume=58 |issue=12 |pages=2133–2142 |doi=10.1111/epi.13920 |pmc=5716856 |pmid=28994113}}</ref>

Although epilepsy surgery has demonstrated strong evidence of efficacy — especially in drug-resistant focal epilepsy — it remains underutilized worldwide and is often reserved for individuals whose condition has reached an advanced or chronic stage.<ref name="Engel2018" /> Early consideration and referral for surgical evaluation can improve long-term outcomes and quality of life. This evaluation, conducted in specialized epilepsy centers, includes seizure classification, long-term video EEG monitoring, high-resolution MRI with epilepsy-specific protocols, neuropsychological assessment, and sometimes functional imaging or invasive monitoring. Early referral improves the likelihood of successful outcomes and avoids prolonged periods of unnecessary disability.<ref>{{Cite journal |last=Rosenow |first=Felix |last2=Bast |first2=Thomas |last3=Czech |first3=Thomas |last4=Feucht |first4=Martha |last5=Hans |first5=Volkmar H. |last6=Helmstaedter |first6=Christoph |last7=Huppertz |first7=Hans-Jürgen |last8=Noachtar |first8=Soheyl |last9=Oltmanns |first9=Frank |last10=Polster |first10=Tilman |last11=Seeck |first11=Margitta |last12=Trinka |first12=Eugen |last13=Wagner |first13=Kathrin |last14=Strzelczyk |first14=Adam |date=2016 |title=Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment |url=https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13449 |journal=Epilepsia |language=en |volume=57 |issue=8 |pages=1215–1220 |doi=10.1111/epi.13449 |issn=1528-1167}}</ref>

The primary goal of epilepsy surgery is to achieve seizure freedom,<ref name="pmid12027916">{{cite journal |vauthors=Birbeck GL, Hays RD, Cui X, Vickrey BG |date=May 2002 |title=Seizure reduction and quality of life improvements in people with epilepsy |journal=Epilepsia |volume=43 |issue=5 |pages=535–538 |doi=10.1046/j.1528-1157.2002.32201.x |pmid=12027916 |doi-access=free}}</ref> but even when that is not possible, palliative procedures that significantly reduce seizure frequency can lead to meaningful improvements in quality of life and development — particularly in children. Studies suggest that 60-70% of individuals with drug-resistant focal epilepsy experience a substantial reduction in seizures following surgery.<ref name="pmid17491501">{{cite journal |vauthors=Duncan JS |date=April 2007 |title=Epilepsy surgery |journal=Clinical Medicine |volume=7 |issue=2 |pages=137–142 |doi=10.7861/clinmedicine.7-2-137 |pmc=4951827 |pmid=17491501}}</ref>

Common procedures include anterior temporal lobe resection, which often involves removal of the hippocampus in cases of mesial temporal lobe epilepsy, as well as lesionectomy for tumors or cortical dysplasia, and lobectomy for larger seizure foci.<ref name="pmid17491501" /> In cases where resection is not possible, procedures such as [[corpus callosotomy]] may help reduce the severity and spread of seizures. In addition to traditional resective techniques, minimally invasive approaches such as MRI-guided laser interstitial thermal therapy (LITT) have gained traction as safer alternatives in select cases, particularly where reducing cognitive impact and recovery time is a priority.<ref>{{Cite journal |last=Sharma |first=Mayur |last2=Ball |first2=Tyler |last3=Alhourani |first3=Ahmad |last4=Ugiliweneza |first4=Beatrice |last5=Wang |first5=Dengzhi |last6=Boakye |first6=Maxwell |last7=Neimat |first7=Joseph S. |date=2020-04-01 |title=Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: a Nationwide Inpatient Sample–based propensity score matching analysis |url=https://thejns.org/focus/view/journals/neurosurg-focus/48/4/article-pE11.xml |journal=Neurosurgical Focus |language=en-US |volume=48 |issue=4 |pages=E11 |doi=10.3171/2020.1.FOCUS19935 |issn=1092-0684|doi-access=free }}</ref> In many cases, antiseizure medications can be tapered following successful surgery, though long-term monitoring remains essential.<ref name="pmid28994113" /><ref name="pmid17491501" /> Surgical treatment is not limited to adults. A 2023 systematic review found that early surgery in children under 3 years with drug-resistant epilepsy can result in meaningful seizure reduction or freedom when other treatments have failed.<ref>{{Cite journal |last1=Tsou |first1=Amy Y. |last2=Kessler |first2=Sudha Kilaru |last3=Wu |first3=Mingche |last4=Abend |first4=Nicholas S. |last5=Massey |first5=Shavonne L. |last6=Treadwell |first6=Jonathan R. |date=2023-01-03 |title=Surgical Treatments for Epilepsies in Children Aged 1–36 Months: A Systematic Review |journal=Neurology |volume=100 |issue=1 |pages=e1–e15 |doi=10.1212/WNL.0000000000201012 |pmc=9827129 |pmid=36270898}}</ref>

Although epilepsy surgery has demonstrated efficacy, it is still rarely used around the world, and is typically reserved for cases where the condition has reached an advanced stage.<ref name="Engel2018" />

==== Neuromodulation ====
[[Neurostimulation|Neuromodulation]] therapies, including [[vagus nerve stimulation]] (VNS), [[deep brain stimulation]] (DBS), and [[Responsive neurostimulation device|responsive neurostimulation]] (RNS), are treatment options for individuals with drug-resistant epilepsy who are not candidates for resective surgery, or for whom previous surgery has not resulted in seizure freedom.<ref name="Cochrane2015">{{cite journal |vauthors=Panebianco M, Rigby A, Marson AG |date=July 2022 |title=Vagus nerve stimulation for focal seizures |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=7 |pages=CD002896 |doi=10.1002/14651858.CD002896.pub3 |pmc=9281624 |pmid=35833911 |doi-access=free}}</ref><ref name="Edwards2017">{{cite journal |vauthors=Edwards CA, Kouzani A, Lee KH, Ross EK |date=September 2017 |title=Neurostimulation Devices for the Treatment of Neurologic Disorders |journal=Mayo Clinic Proceedings |volume=92 |issue=9 |pages=1427–1444 |doi=10.1016/j.mayocp.2017.05.005 |pmid=28870357 |doi-access=free}}</ref><ref>{{Cite journal |last=Englot |first=Dario J |last2=Chang |first2=Edward F. |last3=Auguste |first3=Kurtis I |date=2011 |title=Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response |url=https://pubmed.ncbi.nlm.nih.gov/21838505 |journal=Journal of Neurosurgery |volume=115 |issue=6 |pages=1248–1255 |doi=10.3171/2011.7.JNS11977 |issn=1933-0693 |pmid=21838505}}</ref> These therapies aim to reduce seizure frequency and severity by delivering controlled electrical stimulation to targeted neural circuits.