Epilepsy surgery in children with a normal MRI

Determining candidacy for epilepsy surgery in children with intractable seizures where the MRI is negative is a common challenge facing epilepsy specialists. In recent years there has been an increasing array of investigative approaches that helps to formulate the hypothesis for the epileptogenic zone, with excellent seizure outcomes in some epilepsy surgery series. This narrative review will examine the approach to MRI negative epilepsy surgery in children, with a focus on the need for early recognition of potential surgical candidates, and the preoperative work-up including clinical features and contemporary investigations that help in the decision-making process for surgery. Seizure outcomes in common clinical and pathological subsets are discussed.