American Epilepsy Society/Congress of Neurological Surgeons Epilepsy Surgery Clinical Practice Guideline.
29 affiliations
- 1Department of Neurology, Dartmouth Health and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- 2Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- 3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- 4Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
- 5Department of Neurosurgery, Department of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- 6Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
- 7American Epilepsy Society and Department of Health Sciences, Rush University, Chicago, IL, USA.
- 8Department of Neurology, Dartmouth Health and Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- 9Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
- 10Department of Neurology, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA, USA.
- 11Department of Neurology, Neuromedical Center, Baton Rouge, LA, USA.
- 12Department of Neurology, Duke University Medical Center, Durham, NC, USA.
- 13Neurosurgery Department, University of Minnesota, Minneapolis, MN, USA.
- 14Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA.
- 15Department of Pediatric Neurology, University of Chicago, Chicago, IL, USA.
- 16Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
- 17Patient representative, New York, NY, USA.
- 18Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, CT, USA.
- 19Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- 20Neurology - Epilepsy, The George Washington University, Washington, DC, USA.
- 21Neurosurgery, Yale University, New Haven, CT, USA.
- 22Department of Neurology, The George Washington University, Washington, DC, USA.
- 23Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- 24Department of Neurosurgery, McMaster University, Hamilton, ON, Canada.
- 25Department of Surgery, McMaster University, Hamilton, ON, Canada.
- 26Division of Neurosurgery, McMaster University, Hamilton, ON, Canada.
- 27Department of Neurology, University of Chicago, Chicago, IL, USA.
- 28Department of Health Research Methods, Evidence, and Impact, Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
- 29Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Abstract
This practice guideline from the American Epilepsy Society (AES) and the Congress of Neurological Surgeons (CNS) provides evidence-based recommendations for surgical treatment of epilepsy for adults and children. It is an update to previous practice parameters published by the Academy of Neurology in 2003. The multidisciplinary panel addressed resective procedures for mesial temporal epilepsy (MTLE), neocortical epilepsy, and resection/disconnection of hypothalamic hamartoma. It also examined evidence for callosotomy in developmental and epileptic encephalopathies. It did not intentionally address neurostimulation treatment. A comprehensive literature review was conducted using the Grading of Recommendations Assessment, Development and Education (GRADE) methodology, and GRADE was also used for decision-making. This guideline considers not only seizure outcomes but also other critical and important outcomes. Seizures, quality of life, mortality, adverse events, and verbal memory loss were considered critical outcomes, while other neuropsychological deficits besides verbal memory loss (ie, naming, fluency), neuropsychiatric, and social outcomes were considered important outcomes. Following the GRADE process, the following strong recommendation was made based on a moderate level of evidence: (1) anterior temporal lobectomy (ATL) is recommended for people with MTLE at low risk for cognitive decline. Due to very low to low certainty of evidence the panel suggested the following conditional recommendations: (1) ATL for people with MTLE at high risk for cognitive decline, (2) selective amygdalo-hippocampectomy (SAH) in MTLE, (3) laser interstitial thermal therapy (LITT) in MTLE, (4) neocortical resection in neocortical epilepsy, and (5) callosotomy in people with drop attacks, Lennox-Gastaut Syndrome (LGS) or developmental and epileptic encephalopathies. The panel recognized that conditional recommendations need to account for individual patient circumstances and mandate shared decision-making to ensure that decisions align with each person's values and preferences. For hypothalamic hamartoma, the panel strongly recommended LITT despite low levels of evidence due to a paradigmatic situation where open surgery has significant risks that outweigh the benefits. If LITT is not available, the panel suggested radiosurgery for hypothalamic hamartoma (conditional recommendation). The panel highlighted that every person with drug-resistant epilepsy should have access to a tertiary epilepsy care center that performs surgical procedures and advanced epilepsy diagnostics (good practice statement).
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BibTeX
@article{jobst2026american,
title = {{American Epilepsy Society/Congress of Neurological Surgeons Epilepsy Surgery Clinical Practice Guideline.}},
author = {Barbara C Jobst and Gregory Bergey and Yetiani M Roldán-Benítez and Jennifer L Hopp and David F Bauer and Angela Price and Shawna L Strickland and James L Bernat and Robyn M Busch and Jerome Engel and David Gloss and Aatif M Husain and Robert A McGovern and Guy M McKhann and Douglas R Nordli and John D Rolston and Richard Shane and Dennis Spencer and Howard L Weiner and Mei Bou Nasif and Taylor Duda and Alexandra Eid and Dina Ghandour and Shannon Hart and Mohamad Kesserwan and Amanda Martyniuk and Melissa Lannon and Golbarg T Saber and Christopher Saouda and Sunjay Sharma and Victoria Vinarsky and Andrea J Darzi and Jorge Gonzalez-Martinez},
journal = {Epilepsy currents},
year = {2026},
month = oct,
doi = {10.1177/15357597261465347},
url = {https://europepmc.org/article/MED/42948139},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - American Epilepsy Society/Congress of Neurological Surgeons Epilepsy Surgery Clinical Practice Guideline.
AU - Barbara C Jobst
AU - Gregory Bergey
AU - Yetiani M Roldán-Benítez
AU - Jennifer L Hopp
AU - David F Bauer
AU - Angela Price
AU - Shawna L Strickland
AU - James L Bernat
AU - Robyn M Busch
AU - Jerome Engel
AU - David Gloss
AU - Aatif M Husain
AU - Robert A McGovern
AU - Guy M McKhann
AU - Douglas R Nordli
AU - John D Rolston
AU - Richard Shane
AU - Dennis Spencer
AU - Howard L Weiner
AU - Mei Bou Nasif
AU - Taylor Duda
AU - Alexandra Eid
AU - Dina Ghandour
AU - Shannon Hart
AU - Mohamad Kesserwan
AU - Amanda Martyniuk
AU - Melissa Lannon
AU - Golbarg T Saber
AU - Christopher Saouda
AU - Sunjay Sharma
AU - Victoria Vinarsky
AU - Andrea J Darzi
AU - Jorge Gonzalez-Martinez
PY - 2026
DA - 2026/10/26
JO - Epilepsy currents
DO - 10.1177/15357597261465347
UR - https://europepmc.org/article/MED/42948139
AB - This practice guideline from the American Epilepsy Society (AES) and the Congress of Neurological Surgeons (CNS) provides evidence-based recommendations for surgical treatment of epilepsy for adults and children. It is an update to previous practice parameters published by the Academy of Neurology in 2003. The multidisciplinary panel addressed resective procedures for mesial temporal epilepsy (MTLE), neocortical epilepsy, and resection/disconnection of hypothalamic hamartoma. It also examined evidence for callosotomy in developmental and epileptic encephalopathies. It did not intentionally address neurostimulation treatment. A comprehensive literature review was conducted using the Grading of Recommendations Assessment, Development and Education (GRADE) methodology, and GRADE was also used for decision-making. This guideline considers not only seizure outcomes but also other critical and important outcomes. Seizures, quality of life, mortality, adverse events, and verbal memory loss were considered critical outcomes, while other neuropsychological deficits besides verbal memory loss (ie, naming, fluency), neuropsychiatric, and social outcomes were considered important outcomes. Following the GRADE process, the following strong recommendation was made based on a moderate level of evidence: (1) anterior temporal lobectomy (ATL) is recommended for people with MTLE at low risk for cognitive decline. Due to very low to low certainty of evidence the panel suggested the following conditional recommendations: (1) ATL for people with MTLE at high risk for cognitive decline, (2) selective amygdalo-hippocampectomy (SAH) in MTLE, (3) laser interstitial thermal therapy (LITT) in MTLE, (4) neocortical resection in neocortical epilepsy, and (5) callosotomy in people with drop attacks, Lennox-Gastaut Syndrome (LGS) or developmental and epileptic encephalopathies. The panel recognized that conditional recommendations need to account for individual patient circumstances and mandate shared decision-making to ensure that decisions align with each person's values and preferences. For hypothalamic hamartoma, the panel strongly recommended LITT despite low levels of evidence due to a paradigmatic situation where open surgery has significant risks that outweigh the benefits. If LITT is not available, the panel suggested radiosurgery for hypothalamic hamartoma (conditional recommendation). The panel highlighted that every person with drug-resistant epilepsy should have access to a tertiary epilepsy care center that performs surgical procedures and advanced epilepsy diagnostics (good practice statement).
SN - 1535-7597
SN - 1535-7511
ER -