John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the International League Against Epilepsy

Outcome after epilepsy surgery in children with MRI-negative non-idiopathic focal epilepsies Volume 15, numéro 2, June 2013

Epilepsy Center Kork, Kehl, Germany
  • Mots-clés : epilepsy surgery, childhood, outcome, cryptogenic, MRI, functional imaging
  • DOI : 10.1684/epd.2013.0580
  • Page(s) : 105-13
  • Année de parution : 2013

MRI is one of the most important diagnostic tools in the presurgical evaluation of patients suffering from pharmaco-refractory focal epilepsies. Presence of a lesion on MRI influences both diagnostic classification as well as selection for surgery; however, the implications for MRI-negative cases are far from well defined for such patients. Detection of potentially epileptogenic lesions depends on the techniques applied (high-field MRI, post-processing, etc.) and the experience of the neuroradiologist. The proportion of MRI-negative patients in reported epilepsy surgery cohorts ranges from 16 to 47%. Most MRI-negative patients undergo invasive long-term EEG recordings before a final decision regarding resection is possible. Post-operative seizure freedom rates, with few exceptions, range from 40 to 50%. Selection of surgical candidates and post-operative outcomes may be improved by recent developments in structural and functional imaging techniques and multimodal approaches. This report gives an overview of outcomes after epilepsy surgery in MR-negative patients with a focus on children. Issues regarding definitions, the role of established and recently introduced diagnostic tools, and the question of how outcome might be improved in the future are discussed.