International Journal of Epilepsy 2016; 03(01): 42-62
DOI: 10.1016/j.ijep.2015.12.022
Thieme Medical and Scientific Publishers Private Ltd. 2017

Abstract – 9th AESC Udaipur, 2015

Eun-ik Son
1   Neurosurgery and Epilepsy Center, Keimyung University Hospital, Daegu, Republic of Korea
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Publication Date:
12 May 2018 (online)

How to decide the candidates of epilepsy surgery?

Introduction: Patients are considered for the epilepsy surgery if they have medically intractable epilepsy that interferes with quality of life significantly. Our sequential protocol for presurgical evaluation consists of a battery of tests designed to both lateralize and localize the epileptogenic region. Intractable patients with incidental small lesions on high-resolution MRI could also enter into this protocol to identify adjacent and/or remote epileptogenic areas.

Presurgical evaluation: Phase I (non-invasive studies); All patients evaluated for surgery undergo complete clinical history and detailed semiology, electrophysiologic (scalp EEG and 24-h video-EEG monitoring) and neuroimaging (CT, MRI, SPECT, PET scan) studies, and neuropsychological studies with intracarotid amobarbital procedure (IAP). Data from the noninvasive evaluation are analyzed in an attempt to localize the area of brain responsible for initiation of the patient's habitual seizures. If suggests a localized area responsible for the seizures, surgery is recommended. Phase II (invasive monitoring); Intracranial recordings are performed in patients who may be good candidates for surgery but who do not meet criteria for surgery based on noninvasive evaluation. Multiple types of implanted electrodes, such as subdural strip, grid and/or depth electrodes may be used. The type and location of electrodes are carefully determined to prevent sampling error.

Intraoperative evaluations: Tailored resection for minimalism by intraoperative acute recording (ECoG) and functional brain mapping with the electrical stimulation technique to identify the epileptic and essential areas related to language or sensorimotor are usually performed under local and intravenous propofol anesthesia.

Conclusion: Our protocols to decide the candidates of epilepsy surgery for patients with intractable epilepsy will be presented greater detail along with the subject of the procedural issues of epilepsy care as well.