Drug-resistant epilepsy: resective surgery and neurostimulation

Roughly 30% of people with epilepsy do not respond to multiple lines of anticonvulsants. Drug resistance is defined after two appropriate, well-tolerated drugs fail, and at that point surgical evaluation should not be delayed for years, because ongoing seizures impair cognition.

Pre-surgical evaluation is the core of the process: prolonged video-EEG, high-resolution MRI, PET, neuropsychological testing and, when needed, stereo-electroencephalography (SEEG) with depth electrodes to precisely localise the epileptogenic zone.

If that zone is resectable, neurosurgery (often anterior temporal lobectomy or lesionectomy) achieves complete seizure freedom in 60-70% of properly selected patients. If resection is not viable due to multiple foci or eloquent location, a neurostimulator (VNS or deep brain stimulation) is implanted to modulate aberrant networks and reduce seizure frequency without eliminating it. Risks include memory changes and visual field defects in temporal resections.

Germany, Spain and India maintain neuro-epilepsy institutes coordinating large teams of neurologists, neurophysiologists and neurosurgeons to plan these interventions. The range is EUR 15,000 to 40,000, with fourteen to twenty-one day stays, plus the monitoring phase if SEEG is performed.

At medviajes we compare accredited centres with complete epilepsy surgery programmes and coordinate transfer of video-EEG and imaging, travel and follow-up. The indication must be set by a qualified epilepsy unit.