LAUSR

Epilepsy is a common neurological disease that can affect all ages. Although the majority of people with epilepsy will have excellent seizure control with medication, about 30% will fail anti-epileptic drugs. For those with medically intractable epilepsy, the recurrent seizures lead to increased mortality, risks of injury, and the seizures themselves are socially disabling [1–3]. Fortunately for many people with intractable epilepsy, epilepsy can be cured, or seizures better controlled with surgical treatment [4,5]. Localization of the seizure focus followed by surgical resection provides the best opportunity to cure the epilepsy, and a better understanding of the neuro-anatomy and physiology of epilepsy improves our ability to define the epileptic network and effectively treat the epilepsy [6]. An important advance that has improved patient care is minimal access surgical approaches, which result in more rapid recovery from surgery, less pain, and more satisfied patients [7]. Additionally, for individuals without an opportunity for cure of their epilepsy, new and emerging technologies have promise to reduce seizure frequency and severity, thus improving quality of life and preventing injuries and mortality that result from intractable epilepsy. In this special issue, Boling et al. examines the profound negative consequences of medically intractable epilepsy that impacts the majority of the world’s population who reside in the developing world of Asia and sub-Saharan Africa. Stigma is a major driver of the significantly reduced quality of life of people with epilepsy, which is amplified in severely underserved and low-resource regions of the world due to poverty, severe treatment gaps, high mortality and morbidity of intractable epilepsy, lack of education and knowledge about epilepsy, and widespread misconceptions that epilepsy is related to witchcraft or sorcery as well as beliefs that epilepsy is contagious. Boling et al. then describe proof of principle in the developing world that surgery of medically intractable epilepsy can elevate quality of life and significantly reduce stigma. Even in the developed world, due to seemingly inextricable reasons, wait times for patients with medically intractable epilepsy to be evaluated in a comprehensive epilepsy program are unnecessarily long. The delay to evaluation of surgically remedial epilepsies results in many patients being exposed far too long to the elevated mortality risk and reduced quality of life that results from intractable seizures. Sadanand explores this knotty problem using a novel mathematical approach of non-cooperative game theory. He then contrasts and compares the medical communities approach to glioblastoma multiforme, which has better defined treatment algorithms and expectations of care, with the medical community’s approach to intractable epilepsy treatment, and explains the discrepancies identified using game theory models. Anyanwu et al. reviews the definition of medical intractability and provides a broad overview of the treatment options available to patients who have failed medication. Although approximately 20 anticonvulsant medications are available in North America and Europe today, the authors point out that only two anticonvulsant medications need to be adequately trialed and failed prior to a patient being deemed intractable. The presurgical evaluation particularly EEG and imaging are discussed. Finally the various surgical procedures for both palliative and curative goals are covered. New treatment options have recently become available for epilepsy patients that directly stimulate the brain to suppress the seizure focus. The Neuropace RNS system (Mountain View, CA, USA) is