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ISSN 0028-3851 (Print)

2017, Number 1

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Rev Neurol Neurocir Psiquiat 2017; 45 (1)

75th Anniversary of the Mexican Society of Neurology and Psychiatry. Advances in surgery of temporal lobe epilepsy

Alonso VMA, Buentello GRM, Brust ME, Rubio DF, San Juan OD

Language: Spanish
References: 39
Page: 13-21
PDF size: 450.03 Kb.


ABSTRACT

Following up on the concepts of epileptogenicity and refractoriness as well as significant technological advances we explore the concept of pharmacologically refractory epilepsy and its high biosocial and psychological burden. Evidence from the first randomized trial and surgical results worldwide warrant arguing for early referral of adequately selected temporal lobe epilepsy patients to surgical treatment. The goals of epilepsy surgery are: seizure control, reduction in antiepileptic medications, improvement in quality of life and social rehabilitation. Given that optimal surgical results depend primarily on an adequate selection of surgical candidates we review the necessary elements to perform presurgical evaluations. This individualized study must be contemplated within a standardized comprehensive protocol and include correct diagnosis of refractory epilepsy, systematic review of clinical history, classification of epileptic syndrome, as well as imaging studies (structural, metabolic and functional), neurophysiology studies (EEGs, Video-EEG, and invasive monitoring and magnetoencephalography in selected cases), neuropsychological and neuropsychiatric evaluations and finally a comprehensive case discussion in a multidisciplinary epilepsy committee. We review the most common surgical procedures along with their results in seizure and quality of life outcome. While significant advances are recognized, we discuss the challenges faced by epilepsy surgery, especially in developing countries. The emphasis is on the need to increase timely detection of refractory epilepsy and referral to surgical programs, standardization and optimization of technological and human resources with the adequate insertion of social and professional educational programs.


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