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Nizam

Have you considered surgical options for your patients?

Approximately 1% of the population has epilepsy. A number of studies have documented that 30% of the patients with epilepsy are refractory to medical therapy. Patients with localization related epilepies can be considered for epilepsy surgery. Although selection criteria varies between different centres, a number of pre-requisites need to to be fulfilled.

1. Patient should have localization related epilepsy and not a generalized epilepsy syndrome.
2. Focal lesion on the MRI is associated with a better outcome but not absolutely required for surgical candidacy.
3. Concordance between seizure semiology,EEG findings and neuroimaging heralds a good surgical outcome.
4. Neuropsychological testing if localizing and lateralizing is an additional useful tool.

Patients who have mesial temporal sclerosis on MRI, with localizing EEG findings on the same side, complex partial seizures (mesial temporal lobe epilepsy)usually have a very good post-surgical outcome. Approximately 60-70% may be rendered seizure free with a majority not requiring antiepileptic drugs.

I look forward to hearing from any neurosurgeons on this forum, there thoughts on the feasibility of epilepsy surgery in Pakistan.

Kind regards,

Nizam