The early identification of candidates for epilepsy surgery

The effectiveness of resective surgery for the treatment of carefully selec ted patients with medically intractable, localization-related epilepsy is c lear. Seizure-free rates following temporal lobectomy are consistently 65% to 70% in adults(1,2) and 68% to 78% in children.(3,4) Extratemporal resect ions less commonly lead to a seizure-free outcome, although one recent chil dhood series reported a seizure-free rate of 62% following extratemporal ep ilepsy surgery.(5) With both temporal and extratemporal resections, additio nal patients have a reduction in seizures following surgery but are not com pletely seizure free. The identification of favorable surgical candidates h as been the subject of extensive research, and many investigators have exam ined predictors of outcome following epilepsy surgery. However, the early i dentification of the potential epilepsy surgery candidate and the optimal t iming of surgery have only occasionally been addressed in the literature. T his issue is methodologically challenging to study since studies require la rge numbers of patients with new-onset partial epilepsy who are followed ov er time. The purpose of this article is to review the current ability for e arly prediction of medical intractability in patients with surgically remed iable epilepsy. Emphasis will be placed on the early prediction of intracta ble temporal lobe epilepsy in children and adolescents, since temporal lobe ctomy remains the prototype epilepsy surgery, and early surgery may improve psychosocial outcome in younger patients.(6,7)