Non-invasive evaluation for epilepsy surgery

Research output: Contribution to journalReview articlepeer-review

13 Citations (Scopus)

Abstract

Epilepsy surgery is aimed to remove the brain tissues that are indispensable for generating patient’s epileptic seizures. There are two purposes in the pre-operative evaluation: localization of the epileptogenic zone and localization of function. Surgery is planned to remove possible epileptogenic zone while preserving functional area. Since no single diagnostic modality is superior to others in identifying and localizing the epileptogenic zone, multiple non-invasive evaluations are performed to estimate the location of the epileptogenic zone after concordance between evaluations. Essential components of non-invasive pre-surgical evaluation of epilepsy include detailed clinical history, long-term video-electroencephalography monitoring, epilepsy-protocol magnetic resonance imaging (MRI), and neuropsychological testing. However, a significant portion of drug-resistant epilepsy is associated with no or subtle MRI lesions or with ambiguous electro-clinical signs. Additional evaluations including fluoro-deoxy glucose positron emission tomography (FDG-PET), magnetoencephalography and ictal single photon emission computed tomography can play critical roles in planning surgery. FDG-PET should be registered on three-dimensional MRI for better detection of focal cortical dysplasia. All diagnostic tools are complementary to each other in defining the epileptogenic zone, so that it is always important to reassess the data based on other results to pick up or confirm subtle abnormalities.

Original languageEnglish
Pages (from-to)632-640
Number of pages9
JournalNeurologia medico-chirurgica
Volume56
Issue number10
DOIs
Publication statusPublished - 2016

Keywords

  • Electroencephalography
  • Epilepsy surgery
  • Evaluation
  • Magnetic resonance imaging
  • Semiology

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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