Epilepsy surgery in children and adults

Area of Science:

• Neurology
• Neurosurgery

Background:

• Epilepsy surgery is highly effective for drug-resistant focal epilepsy, improving quality of life.
• Careful patient selection minimizes risks associated with epilepsy surgery.
• Current guidelines advocate for earlier and more systematic surgical eligibility assessments.

Purpose of the Study:

• To review the current state of presurgical evaluation for epilepsy surgery.
• To highlight advancements and evidence gaps in identifying the epileptogenic zone.
• To emphasize the need for high-level evidence to standardize best practices.

Main Methods:

• Review of clinical, neuroimaging, and neurophysiological investigations for presurgical assessment.
• Analysis of progress in presurgical evaluation, especially for MRI-negative epilepsy.
• Assessment of the evidence base for various presurgical investigations.

Main Results:

• Epilepsy surgery can significantly improve cognition, behavior, and quality of life.
• Presurgical assessment methods have advanced, particularly for MRI-negative cases.
• Evidence for the indication and effectiveness of many presurgical investigations is limited.
• No definitive biomarker currently exists for precise epileptogenic zone delineation.

Conclusions:

• Epilepsy surgery is a critical treatment for drug-resistant focal epilepsy.
• Enhanced presurgical assessment is crucial for optimizing surgical outcomes.
• Further research is needed to generate high-level evidence and standardize best practices in epilepsy surgery.