Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Approximately one-third of epilepsy patients experience drug-resistant seizures despite trials of multiple antiepileptic drugs.
• Epilepsy surgery presents a curative option for individuals with focal onset drug-resistant epilepsy.
• Underutilization of epilepsy surgery may stem from the intricate nature of presurgical evaluation.

Purpose of the Study:

• To review the comprehensive presurgical evaluation process for patients with drug-resistant focal onset epilepsy.
• To outline the key steps involved in preparing patients for epilepsy surgery.

Main Methods:

• Review of the established protocols and diagnostic procedures for epilepsy presurgical evaluation.
• Discussion of tests required for seizure classification, lateralization, and localization of the epileptogenic zone.
• Emphasis on neurocognitive assessments to ensure surgical safety regarding language and memory functions.

Main Results:

• The presurgical evaluation is a multi-step process essential for successful epilepsy surgery.
• Accurate classification of seizure type, precise localization of the seizure onset focus, and assessment of potential neurocognitive deficits are critical.
• Each diagnostic step necessitates specialized testing to inform surgical planning.

Conclusions:

• A thorough presurgical evaluation is paramount for optimizing outcomes in epilepsy surgery.
• Understanding and navigating the complexity of presurgical assessment can help increase the utilization of epilepsy surgery for intractable epilepsy.
• This review provides a framework for the systematic evaluation of patients with drug-resistant focal epilepsy.