Preoperative diagnostics and surgical treatment of epilepsy

The surgical treatment of focal epilepsies is not a new form of therapy but was started in the late eighties of the 19th century. For many years epilepsy surgery was carried out in only a relatively small number of centres worldwide. During the last two decades, however, a stormy development has occurred and in Germany, for instance, epilepsy surgery is now offered across the whole country. This development was made possible by the advancement of technology, especially the introduction of simultaneous EEG video monitoring and the modern imaging technique of magnetic resonance tomography. In this synopsis the objectives of the preoperative non-invasive and invasive diagnostic procedures are outlined, the essential tasks of which are to determine the localisation and extension of the epileptogenic zone as well as to make an estimation of possible negative consequences of a cortical resection. The surgical procedures used most often are described. To summarise the current state of the art: surgical treatment is a safe means of therapy with only a low rate of complications. Furthermore, it offers better chances for seizure freedom than any other treatment form currently available.