Objective: To investigate the causes of non-surgical candidates after presurgical evaluation for epilepsy surgery.
Methods: A retrospective review was conducted for the clinical data of 112 non-surgical candidates after presurgical evaluation for epilepsy surgery. Potential surgical candidates were identified through a detailed seizure and medical history, physical examination, and uses of video electroencephalography and neuroimaging.
Results: The common causes of non-surgical candidates after presurgical evaluation for epilepsy surgery were patients and their families giving up intracranial electrode positioning for various reasons (42/112, 37.5%), multifocal epileptogenic zones (29/112, 25.9%), generalized seizures (15/112, 13.4%), pseudoseizure or slight seizure (10/112, 8.9%; 7/112, 6.3%), epileptogenic zone in functional areas (6/112, 5.4%) and so on.
Conclusion: Epilepsy surgery is less likely in patients with a history of severe encephalitis and perinatal brain injury and diffuse, multiple, bilateral abnormality on cranial MRI. Unnecessary presurgical evaluation can be avoided by distinguishing generalized seizures, pseudoseizure and progressive brain disease. Patients and their families still have doubts about the surgical risks, costs and effects. It is important to inform the patients of the potential risks and benefit of surgery.