Presurgical evaluation and surgical treatment of medically refractory epilepsy

Abstract

Thanks to today's modern imaging examination techniques and especially to the common use of intracranial electrodes for localizing seizure foci, more and more patients with partial epilepsy can be treated microsurgically. The results of such neurosurgical therapies are very good, particularly in mesial temporal lobe epilepsy. In recent years, good results (60-70% seizure freedom) have also been achieved in extratemporal epilepsy surgery, so that such procedures can now be recommended for carefully selected patients. In this review, presurgical evaluations and the different surgical approaches are presented.

Interictal SPECT in the presurgical evaluation in epileptic patients with normal MRI or bilateral mesial temporal sclerosis

“…Thus, examinations that enable the localization of the EA are necessary. Magnetic resonance imaging (MRI) is the most sensitive examination in the diagnosis of brain structure abnormalities 7 and is the first-line imaging technique in Epileptic interictal SPECT Marques et al…”

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

“…Though the data are not definitive, there is some evidence suggesting that, among the various seizure types, partial seizures, either simple or complex, may be less likely to respond to antiepileptic drugs than generalized or mixed seizures [93,157,158]. This resistance may be noted initially, so that seizure control is never achieved; but it also may develop over time, so that seizure control is lost and never regained [158,159].…”

“…This resistance may be noted initially, so that seizure control is never achieved; but it also may develop over time, so that seizure control is lost and never regained [158,159]. In such patients, therefore, there may even be an increased incentive to pursue surgical resection of the tumour+/-any adjacent epileptogenic foci, if the lesion can be accessed with no undue risk.…”

Investigations of Brain Network Alterations in Epilepsy Using Functional Magnetic Resonance Imaging

“…The fact that the seizures are generated from a specific focus in the mesial temporal lobe makes many drug-resistant mesial TLE patients good candidates for resective surgery. The success rate for seizure control following surgical resection is approximately 80% (Siegel 2004). In a randomized-control study of surgery vs. antiepileptic drug treatment for temporal lobe epilepsy, 58% of patients became seizure free with surgery vs. 8% on drug therapy (Wiebe, et al 2001).…”