Ethics of Epilepsy Surgery
One percent of the global population, children as well as adults, are affected by epilepsy. In about one third of patients, seizures cannot be adequately controlled by antiepileptic medication. A significant proportion of these patients, especially of those with focal epilepsy, may benefit from epilepsy surgery. Given the patients’ reduced quality of life and the high social and economical burden of uncontrolled seizures, early consideration of epilepsy surgery is recommended. Curative epilepsy surgery procedures aim at abolishing the seizures by removing or disconnecting the area generating the seizures, without causing an unacceptable functional deficit. Palliative procedures aim at reducing the frequency and/or severity of seizures in patients who cannot be rendered seizure-free. Overall, there is a 40–80 % chance of postoperative seizure freedom, with a low risk of perioperative morbidity if the procedure is performed by an experienced neurosurgeon. In adults with temporal lobe epilepsy, two randomized controlled trials have provided evidence of the superiority of surgery over medical treatment alone.
To determine whether a patient is a candidate for epilepsy surgery and which procedure is deemed to produce the most benefit, a comprehensive evaluation needs to be performed, taking into account the type of epilepsy and its expected evolution, the individual aims and the psychosocial situation of the patient, the presence or absence of a resectable structural lesion, and the risks associated with the surgery. This chapter examines the ethical challenges related to epilepsy surgery with respect to patient selection, quality of life, and informed consent.
KeywordsTemporal Lobe Epilepsy Epilepsy Surgery Seizure Freedom Epileptogenic Zone Palliative Procedure
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