GRAY MATTERS In response to commentary on cavernoma- related epilepsy: Review and recommendations for management— Report of the surgical task force of the ILAE commission on therapeutic strategies To the Editors: We thank Dr. Giulioni and colleagues for their interest in our recommendations for the management of caverno- ma-related epilepsy and their comments regarding inva- sive and noninvasive evaluation of these patients. 1 We agree with Dr. Giulioni that unnecessary invasive evalua- tion should be avoided whenever possible in order to min- imize the risk of complications. Invasive evaluation is not recommended as a general rule in our review, but should be limited to certain specific situations mentioned in our recommendations such as discordant results in noninva- sive video-EEG monitoring (VEM) or epileptogenic cavernomas close to eloquent cortex. 2 In these cases, invasive evaluation including mapping of adjacent cortex can be useful to define the localization and extent of the epileptogenic zone and can provide information that helps to resect as much epileptogenic tissue as possible while avoiding eloquent areas. In addition, invasive VEM might be considered in situations where patients could not be rendered seizure free after resection of the cavernoma. In any case, invasive evaluation should certainly be consid- ered only after noninvasive methods have been exploited. We also agree with Dr. Giulioni and colleagues that for some associated pathologies detection by magnetic reso- nance imaging (MRI) is a challenge, which emphasizes the need for more advanced MRI techniques and stronger field strengths as well as histopathologic evaluation. D ISCLOSURE None of the authors has any conflict of interest to disclose that are rele- vant to this manuscript. We confirm that we have read the Journal’s posi- tion on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Felix Rosenow* 1 rosenow@med.uni-marburg.de Mario A. Alonso-Vanegas 2 Christoph Baumgartner 3 Ingmar Bl€ umcke 4 Mar Carre~ no 5 Elke R. Gizewski 6 Hajo M. Hamer 7 Susanne Knake 1 Philippe Kahane 8 Hans O. L€ uders 9 Gary W. Mathern 10 Katja Menzler 1 Jonathan Miller 11 Epilepsia, 55(3):465–469, 2014 Taisuke Otsuki 12 Cigdem Ozkara 13 Asla Pitk€ anen 14,15 Steven N. Roper 16 Americo C. Sakamoto 17 Ulrich Sure 18 Matthew C. Walker 19 Bernhard J. Steinhoff 20 for the Surgical Task Force, Commission on Therapeutic Strategies of the ILAE Department of Neurology, Epilepsy Center Hessen, University Hospital and Philipps-University Marburg, Marburg, Germany; ABC Neurological Center & National Institute of Neurology and Neurosurgery, M exico City, Mexico; Second Neurological Department, Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, General Hospital Hietzing with Neurological Center Rosenh€ ugel, Vienna, Austria; Department of Neuropathology, University Hospitals Erlangen, Friedrich-Alexander University Erlangen- Nuremberg, Erlangen, Germany; Clinical Institute of Neurosciences, Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Department of Radiology, University Clinic for Neuroradiology, Medical University Innsbruck, Innsbruck, Austria; Department of Neurology, Epilepsy Center Erlangen, University Hospitals Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Department of Neurology and GIN INSERM U836-UJF- CEA, University Hospital of Grenoble, Grenoble, France; Department of Neurosurgery, Epilepsy Center, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, Ohio, U.S.A.; Departments of Neurosurgery and Psychiatry & BioBehavioral Medicine, David Geffen School of Medicine, Mattel Children’s Hospital, University of California, Los Angeles, California, U.S.A.; Department of Neurosurgery, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, Ohio, U.S.A.; Epilepsy Center, National Center of Neurology and Psychiatry, Tokyo, Japan; Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey; A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland (UEF), Kuopio, Finland; Department of Neurology, Kuopio University Hospital, Kuopio, Finland; Department of Neurosurgery, University of Florida, Gainesville, Florida, U.S.A.; Department of Neurosciences and Behavioral Science, Ribeir~ ao Preto School of Medicine, University of S~ ao
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