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Resecting Epilepsy 

Resecting Epilepsy
Resecting Epilepsy

Dieter Schmidt

and Simon Shorvon

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date: 24 October 2020

The evolution of surgery for epilepsy in the late nineteenth century was partly the consequence of new ideas about the localisation of function in the brain and advances in the understanding of the physiological nature of epilepsy. This was an exciting time of discovery, and really fundamental and novel principles were enunciated which have stood the test of time. New techniques of investigation, including electroencephalography or magnetic resonance imaging, have since led to more accurate ‘targeting’, allowing the elucidation of the anatomical underpinning of epilepsy to be based, not only on semiology as in the earlier years, but also on more objective structural and functional measures. However, the fact remains that most surgery is based on the concept that resecting ‘bad’ tissue, and thus removing the ‘focus’ of epilepsy, will cure the condition—a postulation which has not changed since the time of Jackson (and which has its roots in earlier superstition). Such theories of epilepsy are surely gross simplifications, and the absence of any subsequent paradigm shift is why surgery has really not advanced conceptually much in the last 50 years. Technique and technology have profoundly changed, but the theoretical basis, generally speaking, has not.

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