Medically-refractory epilepsy
Epilepsy is a common and debilitating neurological disorder that afflicts over 3 million people in the United States alone and up to 1% of the global population. Various forms of seizure disorders are primarily first medically managed with anti-epileptic drugs. However, for a subset of patients who have drug-resistant epilepsy, alternative interventions, including surgical resection or ablation of epileptogenic foci must be pursued for relief from seizures. Stereotactic radiosurgery (SRS) is a treatment that originated in the 1960s and has been utilized for various disease states, including tumors and vascular malformations. Epilepsy, particularly resulting from structural etiologies like mesial temporal sclerosis (MTS) and hypothalamic hamartoma (HH), is another condition where treatment by SRS has been explored. So far, cohort studies and trials have been equivocal with regards to the safety efficacy, and aftereffects of relying on SRS for epilepsy. However, SRS could still be a viable option for patients with refractory epilepsy who are unable to tolerate surgery or are otherwise not candidates for other therapies, such as laser ablation. This chapter reviews the indications, existing data, and future directions of and alternatives to epilepsy treatment by SRS.
