Presurgical Assessment for Epilepsy Surgery

In well-selected patients with pharmaco-resistant focal epilepsy, epilepsy surgery is a highly efficient therapy, leading to seizure freedom or a significant improvement in the majority of patients. A thorough presurgical evaluation with multimodal imaging is necessary to obtain concordant results for the localisation of epileptic activity and of the functionally important cortical and subcortical structures. This allows to tailor resections or the implantation of invasive electrodes and counsel patients about risk of neurological and cognitive deficits. Here review the different conventional as well as more recent localisation techniques and their combination in the light of their validation with clinical studies. Improved diagnostic techniques will hopefully help orient more children and adults with pharmacoresistant epilepsy towards surgery with improved outcomes.