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Surgery

Epilepsy surgery should be considered for any person with epilepsy who is medically refractory. Patients are evaluated on a case-by-case basis in centres that are familiar with and have expertise in epilepsy surgery. Results from a 2023 systematic review found that surgical interventions for children aged 1–36 months with drug-resistant epilepsy can lead to significant seizure reduction or freedom, especially when other treatments have failed. Epilepsy surgery may be an option for people with focal seizures that remain a problem despite other treatments. These other treatments include at least a trial of two or three medications. The goal of surgery has been total control of seizures. However, most physicians believe that even palliative surgery where the burden of seizures is reduced significantly can help in achieving developmental progress or reversal of developmental stagnation in children with drug-resistant epilepsy and this may be achieved in 60–70% of cases. Common procedures include cutting out the hippocampus via an anterior temporal lobe resection, removal of tumors, and removing parts of the neocortex. Some procedures such as a corpus callosotomy are attempted in an effort to decrease the number of seizures rather than cure the condition. Following surgery, medications may be slowly withdrawn in many cases.