Epilepsy surgery for seizure control in individuals with Dravet syndrome: is it a safe and practical option?

Introduction: Dravet syndrome is a severe developmental and epileptic encephalopathy presenting in childhood with drug resistant seizures and multiple comorbidities including developmental and cognitive delays. While medical therapy has continued to advance, leading to improved seizure control, outcomes such as seizure freedom remain elusive. As the underlying cause of Dravet syndrome is a genetic channelopathy, epilepsy surgery is rarely considered.

Areas covered: The authors weigh up the potential benefits of surgical therapy when seizure reduction, but not seizure freedom, is expected, discussing the literature related to surgical therapy in patients with Dravet syndrome and other similar genetic conditions.

Expert opinion: In general, people with Dravet syndrome are rarely favorable candidates for epilepsy surgery, yet surgery is not necessarily contraindicated. Meaningful seizure reduction can be achieved in highly selected cases with perhaps the most benefit arising from neuromodulation procedures such as vagus nerve stimulation. It remains uncertain whether seizure reduction following surgery contributes to any non-seizure benefits.