[Epilepsy surgery: when thinking about? Who are the good candidates?]

Abstract

Epilepsy surgery concerns any patient with pharmacoresistant partial epilepsy, responsible for disability. Children and adult patients can be candidates for epilepsy surgery. A presurgical evaluation, adapted to each patient, must identify the most precisely the cortical area, where the seizures originate, using converging data: the clinical and electroencephalographic semiology of the seizures, the structural and sometimes functional brain imagings, and evaluate if the removal of the epileptogenic focus may induce a neurological or cognitive deficit, using neuropsychological tests and sometimes functional brain imagings. Such therapeutical strategy should be evoked as soon as possible in patients for whom the epilepsy becomes pharmacoresistant, and these patients should be oriented in specialized centres. The results of epilepsy surgery vary according to the lobar origin of the epileptogenic focus and to the existence of a visible lesion on brain MRI. A multidisciplinary evaluation of the benefits and risks should be presented to the patient. Results of the surgery are usually excellent when a focus is clearly identified and the neuropsychological tests did not predict a deficit.