The patient’s perception that his or her disability is worth taking the risk of a surgical treatment plays a major

role in deciding to proceed to a presurgical evaluation. However, this judgment is not always based on realistic expectations of postoperative outcome, and thus needs to be balanced with the physician’s more objective view of the risk:benefit ratio of epilepsy surgery. Regarding drug resistance, there is a general agreement to consider a patient medically refractory if two or more appropriately selected and managed AEDs failed to control his or her seizures.14 Indeed, once a patient has Inhibitors,research,lifescience,medical not responded to the first two drugs, the likelihood of achieving sustained seizure freedom Inhibitors,research,lifescience,medical with any other medical treatment is less than 5%.15 A 2-year follow-up is also usually required to conclude on the presence of a refractory epilepsy in adult patients. However, shorter epilepsy duration can be accepted in epileptic children with catastrophic epilepsies.2 The third Inhibitors,research,lifescience,medical criterion to be considered, ie, the identification of a surgically

AZD8055 molecular weight remediable epileptic syndrome, has been classically defined as the presence of a symptomatic or cryptogenic localization-related epilepsy, whose suspected underlying epileptogenic zone (EZ) should be unique, and not overlapping with eloquent brain regions. However, important progress has been made in the field, allowing widening of the scope of epileptic syndromes amenable to surgery. These now include patients with various forms of symptomatic generalized epilepsies, such as infantile spasms associated with cortical Inhibitors,research,lifescience,medical dysplasia,16,17 seemingly multifocal partial epilepsy related to tuberous sclerosis,16,18 EZ involving eloquent areas,19,20 Inhibitors,research,lifescience,medical Landau-Kleffner syndrome,16 and patients combining a surgically remediable partial epilepsy

and an idiopathic generalized epileptic syndrome with the hope of curing the former with surgery, allowing a more appropriate A ED regimen to control the latter.21 In addition, Etomidate palliative surgical treatments, such as callosotomy and deep brain stimulation, can be proposed in patients with other forms of severe cryptogenic or symptomatic generalized epilepsies, including Lcnnox-Gastaut syndrome.22 To summarize, the eligibility criteria required to enter a presurgical evaluation in 2008 should be relatively liberal, provided that the patient suffers from disabling seizures unrelated to an idiopathic generalized epileptic syndrome, despite appropriate AED treatment. However, the decision as to whether or not to perform a presurgical evaluation must be individualized, and must take into account the likelihood of meeting the patient’s expectations in terms of outcome.