Presurgical evaluation of epilepsy patients

Giedrė Gelžinienė, Milda Endzinienė, Nerija Vaičienė, Michel R. Magistris¹, Margaritta Seeck¹

Department of Neurology, Kaunas University of Medicine, Lithuania, ¹Faculty of Medicine, Geneva University, and Presurgical Epilepsy Unit and Neurology Department, University Hospital of Geneva, Switzerland

Key words: pharmacoresistant epilepsy; epileptogenic zone; epilepsy surgery.

Summary. Epilepsy surgery has been established as an effective treatment in pharmacoresistant focal epilepsies. Most candidates for epilepsy surgery are patients with partial epilepsy syndromes refractory to medical treatment. The curative surgery procedure is resection of the epileptogenic zone; therefore, precise detection of the site responsible for seizure generation is necessary. Modern structural and functional imaging techniques have made presurgical evaluation less invasive and available for a higher number of patients. Video electroencephalography (EEG) monitoring, high-resolution structural and functional imaging techniques are used widely for presurgical evaluation. When noninvasive evaluation is not sufficient for the detection of the epileptogenic zone, invasive EEG monitoring and intracarotid amobarbital test are used.

A classical example of a surgically curable epilepsy syndrome is mesial temporal lobe epilepsy with about 70–80% of patients becoming free of seizures after surgery. Results in extratemporal epilepsies are also satisfactory.

Despite worldwide expansion during the recent decade, epilepsy surgery remains underutilized. Better understanding of advances in presurgical evaluation should reduce fears of epilepsy surgery and help to select patients who could achieve complete seizure control or significant amelioration after surgery.

Correspondence to G. Gelžinienė, Department of Neurology, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: giedregelziniene@hotmail.com

Received 18 January 2008, accepted 6 August 2008