Pre-surgical neurophysiological evaluation in epilepsy resistant to treatment protocol
Summary. Introduction. Nowadays approximately twenty per cent of epileptic patients who are on a pharmacological treatment carry on their fits. Their instability can be eliminated with an operation in any center that is specialized in epileptic surgery. The center must have a cross disciplinary team. Development. The ideal operation is one that only eliminates the tissue needed to end up with the fits The main goal of the neurophysiological evaluation is to delimit the cerebral area that generates an epileptogenic activity so as to be able to eliminate it without causing further damage. We present a medical record of pre-surgical neurophysiological evaluation that we would like to put into practice in our department in coordination with the services of neurology, radiodiagnosis, and neurosurgery. This medical record contains the following sections: 1. Selection of patients. 2. Non invasive pre-surgical evaluation. 3. Invasive pre-surgical evaluation. 4. Postsurgical evaluation. The invasive pre-surgical evaluation constitutes the most interesting part of the whole process, it allows thanks to intracranial registers to locate accurately epileptogenic focuses; what is more, it allows to carry out a functional mapping of areas that cannot be explored with surface techniques; and finally this evaluation allows to open new fields of investigation about the way in which the encephalon works. Conclusion. Epilepsy surgery is a subject to develop in Spain in which the neurophysiologic exploration is something essential
Desarrollo El objetivo de la evaluación neurofisiológica es identificar el área cerebral que genera una actividad epileptógena y que ésta pueda ser eliminada sin causar daños neurológicos o cognitivos adicionales. Presentamos un protocolo de evaluación neurofisiológica prequirúrgica con los siguientes apartados: 1. Selección de pacientes. 2. Evaluación prequirúrgica no invasiva. 3. Evaluación prequirúrgica invasiva. 4. Evaluación posquirúrgica. La evaluación prequirúrgica invasiva constituye la parte más interesante de todo el proceso; permite mediante registros intracraneales EEG localizar con precisión focos epileptógenos y realizar una cartografía funcional de áreas del encéfalo no explorables con técnicas de superficie, así como abrir nuevas líneas de investigación sobre el funcionamiento del encéfalo. La cirugía de la epilepsia es un procedimiento en desarrollo en España pero en un futuro puede permitir a epilépticos muy incapacitados llevar una vida normal. La evaluación neurofisiológica es una parte imprescindible de este proceso ya que puede aportar muchos hallazgos sobre zonas funcionales y su relación con la epilepsia
