Epilepsy Surgery Evaluation

Abstract The use of numerous types of electroencephalography (EEG) in the evaluation of people with refractory partial epilepsy for possible resective surgery remains integral to the comprehensive epilepsy evaluation. A progression in the use of the various forms of EEG, from routine EEG to intracranial recordings, remains integral to the person with epilepsy and the evaluation process when contemplating therapeutic epilepsy surgery. Surgery remains a potentially curative procedure for people with intractable epilepsy. Using a multidisciplinary team to evaluate the patient with epilepsy requires that essential elements of the evaluation are in agreement before surgery is offered. The use of specialized tests and sometimes invasive EEG recording techniques can assist in localizing the ictal zone for possible surgical resection when standard monitoring techniques are not conclusively localizing. Continued study of high-frequency oscillations, stereoelectroencephalography (SEEG), and perhaps chronic EEGs (implantables and wearable devices) may provide even more surgery for the person with epilepsy. SEEG is becoming more widely utilized and may provide improved localization in many cases. The utilization of many specific clinical neurophysiology (CNP) techniques remains essential to the presurgical evaluation process for people with epilepsy. This chapter reviews the techniques and approach to surgical evaluation of patients with intractable epilepsy.