Surgical Treatments, Devices, and Nonmedical Management of Epilepsy - Nonmedical Management of Epilepsy

Oct 20, 2026

Many patients with epilepsy cannot achieve optimal seizure control with antiseizure medication, prompting evaluation of nonpharmacologic options. The article reviews surgical approaches, dietary therapies such as the ketogenic diet, and seizure detection devices designed to alert caregivers during convulsive events and potentially reduce SUDEP risk. It emphasizes referral to comprehensive epilepsy centers for patients with drug-resistant epilepsy to determine candidacy for these interventions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Abstract

Objective

Latest Developments

Essential Points

Introduction

Epilepsy Surgery

Indications for Surgical Treatments

Drug-Resistant Epilepsy Definition

Surgical Treatments, Devices, and Nonmedical Management of Epilepsy By Daniel Friedman, MD, MSc ABSTRACT OBJECTIVE: Many patients with epilepsy are unable to achieve optimal seizure control with medical therapy. This article focuses on surgical approaches, dietary therapies, and seizure detection devices. LATEST DEVELOPMENTS: For more than a century, resective epilepsy surgery has been a treatment option for some patients with drug-resistant epilepsy. Other surgical options have emerged for patients for whom resection is not possible or is associated with unacceptable risks, including minimally invasive epilepsy surgery and neurostimulation therapies. Dietary therapies, such as the ketogenic diet, can also help improve seizure control, especially in children. For patients with ongoing nocturnal convulsive seizures, seizure detection devices can alert caregivers and potentially reduce the risk of sudden unexpected death in epilepsy (SUDEP) . ESSENTIAL POINTS: Patients with drug-resistant epilepsy should be referred to comprehensive epilepsy centers to determine if they qualify for nonpharmacologic treatment options to reduce the risk of seizures and premature death and improve quality of life. INTRODUCTION A lthough many people with epilepsy will become seizure free with antiseizure medication, about one-third of patients continue to have seizures despite the availability of many new antiseizure medications over the past 20 years.1 Consequences of ongoing seizures include cognitive and neuropsychiatric decline, social and economic disruption, poor quality of life, risk of injury, and increased mortality.2 In children, ongoing seizures can lead to neurodevelopmental delay or regression.3 Therefore, it is essential to consider other treatment options for patients who are not responding to antiseizure medications, especially if they are having disabling seizures. Several surgical approaches to epilepsy treatment are available. Some patients with drug-resistant epilepsy may become seizure free with epilepsy surgery because their seizures arise from a single area of the brain that can be safely resected or ablated. Although some patients may not be candidates for a curative approach, palliative surgical procedures or neurostimulation devices can lead to a meaningful reduction in seizures and improved outcomes. Other REVIEW ARTICLE 􀀁 CONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE CITE AS: CONTINUUM (MIN NEA P M INN) 2025;31(1, EPILEPSY):165–186. Address correspondence to Dr Daniel Friedman, NYULangone Comprehensive Epilepsy Center, 223 E 34th St, New York, NY 10016, Daniel. [Friedman@nyulangone.org](Friedman@nyulangone.org). RELATIONSHIP DISCLOSURE: Dr Friedman has received personal compensation in the range of $500 to $4999 for serving as a speaker for the American Academy of Neurology, the Epilepsy Foundation, and SK Life Science, Inc, and as a consultant for Meili Technology, Inc; in the range of $5000 to $9999 for serving on a scientific advisory or data safety monitoring board for Neurelis, Inc; and in the range of $50,000 to $99,999 for serving as a consultant for The Epilepsy Study Consortium. Dr Friedman has stock inNeuroview Technology, has received intellectual property interests from a discovery or technology relating to healthcare, and has received publishing royalties from a publication relating to health care. The institution of Dr Friedman has received research support from the Centers for Disease Control and Prevention, Epitel, the National Institutes of Health, and NeuroPace, Inc. UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Friedman reports no disclosure. © 2025 American Academy of Neurology. CONTINUUM JOURNAL . COM 165 Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited. SURGICAL TREATMENTS, DEVICES, AND NONMEDICAL MANAGEMENT OF EPILEPSY nonpharmacologic treatments for seizures in patients with drug-resistant ep

FAQs

Why do patients with epilepsy need options beyond antiseizure medications?

About one-third of patients continue to have seizures despite many newer antiseizure medications. Ongoing seizures can cause cognitive, neuropsychiatric, social, and economic harm, as well as increased injury risk and mortality.

What surgical approaches are discussed for drug-resistant epilepsy?

The document covers resective surgery for patients whose seizures arise from a single brain area that can be safely removed or ablated, as well as minimally invasive epilepsy surgery and palliative neurostimulation therapies when resection is not possible or carries unacceptable risk.

How do dietary therapy and seizure detection devices support seizure control?

Dietary therapy, especially the ketogenic diet, can improve seizure control, particularly in children. Seizure detection devices can alert caregivers to convulsive seizures and may help reduce the risk of sudden unexpected death in epilepsy (SUDEP).

Oct 20, 2026

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