Correlation of criteria used for localizing epileptic foci in patients considered for surgical therapy of epilepsy

Authors

  • Dr. Jerome Engel Jr MD, PhD,

    Corresponding author
    1. Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, CA 90024
    2. Brain Research Institute, UCLA School of Medicine, Los Angeles, CA 90024
    • Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, CA 90024
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  • Rebecca Rausch PhD,

    1. Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, CA 90024
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  • Jeffrey P. Lieb PhD,

    1. Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, CA 90024
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  • David E. Kuhl MD,

    1. Brain Research Institute, UCLA School of Medicine, Los Angeles, CA 90024
    2. Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA 90024
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  • Paul H. Crandall MD

    1. Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, CA 90024
    2. Brain Research Institute, UCLA School of Medicine, Los Angeles, CA 90024
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Abstract

Criteria for anterior temporal lobectomy, performed on seven patients with partial complex seizures, were derived from a battery of fourteen presurgical tests. Seven tests were routine studies aimed at identifying a focus of epileptic excitability, while seven were designed to reveal areas of focal functional deficit. Conflicting information was frequently obtained from the tests of epileptic excitability, suggesting that it is probably inaccurate to view patients with partial complex seizures as having a single epileptogenic focus. Presurgical evaluation must therefore be aimed at identifying the focus most responsible for the patient's habitual seizures. Tests of focal functional deficit provided useful nonconflicting confirmatory information in each of the seven patients studied. The most reliable information was obtained from depth electrode implantation, and this procedure should be considered essential except when all evidence of surface-recorded epileptic excitability, including ictal onset, and evidence of focal functional deficit agree.

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