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Clinical Crossroads
Clinician's Corner
December 3, 2008

A 24-Year-Old Woman With Intractable SeizuresReview of Surgery for Epilepsy

Author Affiliations

Author Affiliations: Dr Schomer is Director, Laboratory of Clinical Neurophysiology, and Chief of the Comprehensive Epilepsy Program, Beth Israel Deaconess Medical Center, and Professor of Neurology, Harvard Medical School, and Dr Black is Chairman, Department of Neurosurgery, Brigham and Women's Hospital and Children's Hospital Boston, and Franc D. Ingraham Professor of Neurosurgery, Harvard Medical School, Boston, Massachusetts.

JAMA. 2008;300(21):2527-2538. doi:10.1001/jama.2008.709

Epilepsy, a recurrent seizure disorder affecting 1% of the population, can be genetic in origin and thereby affect multiple members in a family, or it can be sporadic. Many sporadic seizures come from a specific “focus” in the cortex. Focal-onset seizures account for 60% of all cases of epilepsy. Among patients with partial seizures, 35% respond poorly to available medication and may benefit from neurosurgical excisional surgery. In cases in which epilepsy is localized through different modes (electroencephalogram, magnetic resonance imaging, etc) to a specific area of the brain where there is an associated lesion, more than half of patients can expect a successful surgical outcome. In patients with consistent seizure-associated behavior but without a lesion, surgical treatment is less successful. Ms H, a young woman with a history of medically intractable partial epilepsy, does not have an anatomical lesion but wants to know if a surgical approach is a good option for her.