Abstract
Surgery remains a therapeutic option for patients with medically refractory epilepsy. Comprehensive presurgical evaluation includes electroencephalography (EEG) and video EEG in identifying patients who are likely to benefit from surgery. Here, we discuss in detail the utility of EEG in presurgical evaluation of patients with temporal lobe epilepsy along with illustrative cases.
Highlights
Temporal lobe epilepsy (TLE) is the most common form of epilepsy worldwide
Preoperative interictal EEG abnormalities commonly observed in TLE are focal arrhythmic slowing and focal interictal epileptiform discharges (IEDs) that are often restricted to the anterior temporal areas (Figures 1(a) and 1(b))
These abnormalities correlate well with seizure onset zone (SOZ) and the structural abnormalities seen on magnetic resonance imaging (MRI)
Summary
Temporal lobe epilepsy (TLE) is the most common form of epilepsy worldwide. Anterior temporal lobectomy (ATL) for medically refractory TLE secondary to mesial temporal sclerosis (MTS) is the most commonly performed surgical procedure in many of the comprehensive epilepsy management centres. Surgery is ideally directed towards complete seizure freedom without or with very minimal cognitive or functional deficits. Wiebe et al in 2001 published the only randomised control study demonstrating the effectiveness of surgery in adults with medically refractory TLE [1]. We would like to emphasise that the art of presurgical workup is to effectively use all the clinical, imaging, and electrophysiological information to localize the seizure onset zone (SOZ) and the epileptic network. The electroencephalography (EEG) aspects of TLE with relevance to surgery are discussed with illustrative cases (see Table 1)
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