Seminars in epileptology: Presurgical epilepsy evaluation

All patients with drug-resistant seizures benefit from a comprehensive evaluation to confirm their seizure diagnosis and explore surgical treatment options. This seminar in epileptology discusses advancements in the field and provides specific didactic material to create an active working knowledge for the care of patients with focal drug-resistant epilepsy. The article reviews indications for a presurgical evaluation and the importance and benefits of early surgical intervention. Advancements in diagnostic techniques in the presurgical evaluation, including video-EEG monitoring, imaging, neuropsychological testing, and patient selection for invasive monitoring, are covered. An overview of common pathologies underlying surgical epilepsy syndromes and their MRI correlates is provided. A modern multimodal work-up allows individualized risk and benefit estimation and a personalized approach to surgical decision-making. The review concludes with a comprehensive discussion of postsurgical management, common complications, and rehabilitation after epilepsy surgery.