[Drug-resistant partial epilepsies: introductory remarks on their classification, pathophysiology and surgical...

There is no validated classification of drug-resistant partial epilepsies in adults that have proved helpful to individualize homogeneous groups of patients, whose clinical course would be predictable at the early stage of the disease and whose treatment, eventually surgical, could be standardized. The only entity fitting with this definition is the syndrome of mesio-temporal lobe epilepsy, which accounts for a high percentage of surgical treatment indications. However the objective to perform surgical treatment in all of these patients is far from being reached in France, as in many other developed countries. Apart from this syndrome, therapeutic decisions are mostly based on case by case clinical and electrophysiological analysis of seizures, in relation with the localization and anatomy of the causal lesion, when the latter can be identified using brain MRI. The pragmatic approach consists in aiming at a consensus regarding the nature and the reliability of presurgical strategies, including invasive electrophysiological investigations, rather than in elaborating a syndromic classification, the pertinence of which cannot be validated. Some concepts and data that might be helpful to reach a consensus are discussed in this brief review article.