The role of the neurologist in presurgical selection of patients with epilepsy

M. Manfredi, M. Capozza, M. T. Faedda, L. Fusco, A. T. Giallonardo, C. Iani, C. Matteucci, D. Mattia, D. Paciello, U. Perugino, S. Ricci, G. Sideri

Research output: Chapter in Book/Report/Conference proceedingChapter


Out of 1842 pts with epilepsy attending our Center since 1970 only 24 pts have been selected for surgery. Since 644 pts with focal epilepsy were non-responders to medical treatment, and 25 per cent of those who underwent intensive video-EEG monitoring proved surgical candidates, one would expect at least 160 pts to be referred for surgery. The AA. conclude that the main reason for such a limited output is the medically-oriented attitude of many clinical neurologists. An imporant role is also played by the difficulties of presurgical selection and patients' fear of surgery. Pts often refuse surgery, because it is presented as their 'last chance'. The AA. therefore suggest that surgical and medical strategies should be explained together, right from the initial consultations. A standard protocol for planning medical therapy is proposed, in order to identify those pts who do not respond to antiepileptic drugs within 2-3 years from onset of disease. The neurologist should place candidates for surgery into three categories: 1. pts with foci in cortical areas that can be removed without risks; 2. pts with foci near cortical areas likely to cause post-surgical neurological deficits: and 3. pts with multiple foci. Invasive investigations should be reserved for the last two categories only.

Original languageEnglish
Title of host publicationBollettino - Lega Italiana contro l'Epilessia
Number of pages4
Publication statusPublished - 1988

ASJC Scopus subject areas

  • Clinical Neurology


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