[Epilepsy surgery in adult patients: for whom?]

Eligibility criteria for epilepsy surgery in adult patients are not clearly defined, depending in most cases on many individual factors (type and severity of the epilepsy, age, comorbidity.) which are discussed for each case. Practically, the main issue consists in identifying those patients who should be referred to an epilepsy surgery center, the role of this latter being to confirm whether the patient is really a good epilepsy surgery candidate, and to decide what kind of investigation and what type of surgery must be performed. Currently, surgery should be only discussed in patients suffering from partial seizures, and in whom at least two antiepileptic drugs have failed. Data in the literature suggest that patients aged under 50 years, suffering from a lesional epilepsy, and whose seizures are suspected to arise from the temporal lobe, have the best benefit/risk ratio and might be consequently referred in priority to specialized centers. These criteria remain only indicative and they cannot account for all the individual situations which have to be dealt with.