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Complicated epilepsy surgery: importance of balancing benefit and deficit
  1. John S Duncan1,
  2. Virginia Beech2,
  3. Fahmida Amin Chowdhury1,3,
  4. Anna Miserocchi1,4,
  5. Andrew McEvoy1,4
  1. 1Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, UCL, London, UK
  2. 2Middlesbrough, UK
  3. 3Neurology, National Hospital for Neurology and Neurosurgery, London, UK
  4. 4Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Prof John S Duncan, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, UCL, London, UK; j.duncan{at}ucl.ac.uk

Abstract

The risk-benefit ratio of epilepsy surgery needs careful consideration, is different for each individual and requires a careful, informed dialogue between the person concerned and their medical advisers. We illustrate this process with Virginia, who has had refractory focal epilepsy from age 1 year and a left hemiparesis. At the age of 45 years, we discussed the possibility of epilepsy surgery and went through non-invasive investigations with structural and functional MRI, tractography, scalp video-EEG telemetry, neuropsychological and neuropsychiatric evaluations. This was followed by a decision to carry out intracranial EEG to define the area of seizure onset and its relation to an area of focal cortical dysplasia, eloquent cortex and tracts. We agreed to carry out a focal resection in the knowledge that this would result in a loss of left-hand function. One year later, Virginia is seizure-free on reduced medication. We describe the steps in the process with Virginia’s views.

  • EPILEPSY
  • SURGERY
  • HEMIPLEGIA

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Footnotes

  • X @Fahmida

  • Contributors JD, VB, FAC, AMi and AMc all made substantial contributions to the acquisition of data for the work. And also all: drafted parts of this paper and revised the whole paper critically for important intellectual content. Approved the final version to be published. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned. Externally peer reviewed by Khalid Hamandi, Cardiff, UK.