Evaluation for surgical treatment of partial epilepsy: an overview

When a focal epilepsy proves refractory to medical therapy, surgical treatment is available and increasingly used. Most interventions consist of focal cortical resections, and by far the most common operation is a temporal lobectomy. The presurgical evaluation is complex and multidisciplinary. It includes clinical evaluation, EEG-video monitoring, neuropsychological testing, and structural as well as functional imaging. When surface EEG fails to identify the epileptogenic zone with sufficient confidence, several invasive methods are available, each with its advantages and limitations. In addition to neurophysiologic data, when there is convergence of structural imaging (MRI) and functional testing (Wada test, neuropsychological evaluation, nuclear imaging), a single focus can be identified, and a focal resection is likely to be successful. Surgery is a well-accepted and effective therapeutic modality for patients with refractory epilepsy. When surgical candidates are selected appropriately, results are excellent, especially for temporal lobe epilepsy.