Resecting without detecting the lesion in extratemporal lobe epilepsy?

Abstract

Nonlesional extratemporal lobe epilepsy (ETLE) often persists following resection of the site of ictal onset, localized with definitive intracranial EEG recordings.(1,2) In lesional ETLE, however, lesionectomy with resection of a single electrophysiologically defined ictal onset (ictogenic) zone often stops seizures immediately and permanently.(1,2) In temporal lobe epilepsy (TLE), a single ictogenic site can be resected, either with an accompanying lesion or in the absence of an MRI-detected lesion, and is a highly efficacious epilepsy therapy.(2) Efforts to increase surgical efficacy in nonlesional ETLE have focused on localization by functional imaging to substitute for lesion localization by structural imaging.