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Presurgical evaluations of patients with intractable epilepsy

Correspondence to:
Correspondence to:
Dr R P Lesser
Epilepsy Center, The Johns Hopkins Medical Institutions, 2-147 Meyer Building, 600 North Wolfe Street, Baltimore, MD 21287-7247, USA; rl@jhmi.edu

Keywords: epilepsy surgery; normal neuroimaging; MRI; intracranial electrodes

The first 150 words of the full text of this article appear below.

It seems straightforward: find the seizure focus, take it out, the seizures stop. Advances in neuroimaging and in electroencephalography (EEG), including the use of intracranial electrodes, should make this even easier.

In this issue, Alarcón et al(see page 474) compare the results of seizure surgery among patients with normal, or with abnormal, neuroimaging and who did, or did not, undergo recordings with intracranial electrodes.¹ All patients had scalp EEG and magnetic resonance imaging (MRI). Intracranial (subdural or sometimes depth) electrodes were placed when neuroimaging was normal. For all patients, about half became seizure free (Engel class I); about three quarters improved considerably (Engel classes I and II). There were no significant differences based on neuroimaging results, or on the use of intracranial electrodes. The authors correctly point out that these results indicate that surgery can control seizures even when neuroimaging is normal. However, in addition, specialised methods . . . [Full text of this article]

Relevant Article

Is it worth pursuing surgery for epilepsy in patients with normal neuroimaging?

G Alarcón, A Valentín, C Watt, R P Selway, M E Lacruz, R D C Elwes, J M Jarosz, M Honavar, F Brunhuber, N Mullatti, I Bodi, M Salinas, C D Binnie, and C E Polkey
J. Neurol. Neurosurg. Psychiatry 2006 77: 474-480. [Abstract] [Full Text] [PDF]