Standardized presurgical evaluation in drug-resistant epilepsy
DOI:
https://doi.org/10.52692/1857-0011.2025.2-82.08Keywords:
drug-resistant epilepsy, presurgical evaluation, video-EEGAbstract
Introduction: Drug-resistant epilepsy (EFR) affects approximately one-third of patients diagnosed with epilepsy and is associated with considerable morbidity. Epilepsy surgery is an effective therapeutic option but requires rigorous presurgical evaluation to ensure proper candidate selection and to minimize functional risks. Aim of study: To provide a comprehensive synthesis of the standardized presurgical evaluation stages in drug- resistant epilepsy, with a focus on the integration of noninvasive and invasive techniques for accurate delineation of the epileptogenic zone and protection of eloquent cortical areas. Materials and Methods: We performed a literature review of relevant studies and guidelines encompassing the four phases of presurgical evaluation. The specific value, diagnostic accuracy, and limitations of each method were analyzed in the context of constructing the epileptic network hypothesis. Results: Multimodal integration of clinical, neuroimaging, and neurophysiological data enables precise localization of the epileptogenic zone in over 70% of selected cases, significantly improving the likelihood of curative surgical outcomes. Functional invasive mapping plays a key role in reducing postoperative morbidity in surgeries involving eloquent cortex. Conclusions: A standardized, stepwise, and individualized presurgical evaluation is essential in managing drug- resistant epilepsy. Careful application of available methods allows for optimal surgical candidate selection, ensuring afavorable balance between therapeutic efficacy and functional safety.
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