engleski

Pre-surgical investigations in patients with pharmacoresistant epilepsies - phase I and II

Despite the availability of the new generation of antiepileptic drugs (AED), whose development began after 1989 and continues until today (the last antiepileptic drug of the new generation was registered in 2012), even after the inclusion of the first and second AEDs in monotherapy and rational dual or polytherapy, almost 30-35% of patients still remained refractory and required neurosurgical treatment. Therefore, the ILAE has clearly defined the pre-surgical evaluation algorithms. After the careful selection, the patients undergo pre-surgical evaluation, which should define a clear semiology of seizures, epileptogenic lesion(s) or zone, symptomatogenic zone, irritative, ictal zone, and the zone of potential functional neurological defi cit. Therefore, Phase I includes non-invasive methods, such as prolonged video-EEG polygraphic monitoring, neurophysiological testing, psychiatric examination, and sophisticated neuroradiological and functional imaging methods. Experience has shown that it is obligatory to do preoperative high resolution MRI with MR spectroscopy, functional MRI with tractography and hippocampal volumetry. MATLAB program is an extremely useful diagnostic procedure that allows the co-registration of MRI 3T with MAP07 software, which is important in the diagnosis of MRI negative or MRI minor cortical dysplasias, complex malformations of cortical development or cases of dual pathology. Furthermore, Phase I includes interictal and ictal SPECT and MAP07 co-registration, or SISCOM and brain PET. Phase II includes the implementation of semi-invasive and invasive procedures, such as Wada test, which is now replaced with functional MRI, semiinvasive EEG monitoring with the implantation of sphenoidal and foramen ovale electrodes, and invasive EEG monitoring after the implantation of the subdural strip and grid electrodes and depth electrodes with or without cortical stimulation.

epilepsy ; pharmacoresistance ; surgery ; investigation

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