• Philippe Ryvlin, J Helen Cross, and Sylvain Rheims.
• Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France; Lyon's Research Neuroscience Center, Institut National de la Santé et de la Recherche Médicale U1028, Centre National de la Recherche Scientifique 5292, Lyon, France; Department of Clinical Neurosciences, Centre Hospitalio-Universitaire Vaudois, Lausanne, Switzerland. Electronic address: philippe.ryvlin@chu-lyon.fr.
• Lancet Neurol. 2014 Nov 1;13(11):1114-26.

AbstractEpilepsy surgery is the most effective way to control seizures in patients with drug-resistant focal epilepsy, often leading to improvements in cognition, behaviour, and quality of life. Risks of serious adverse events and deterioration of clinical status can be minimised in carefully selected patients. Accordingly, guidelines recommend earlier and more systematic assessment of patients' eligibility for surgery than is seen at present. The effectiveness of surgical treatment depends on epilepsy type, underlying pathology, and accurate localisation of the epileptogenic brain region by various clinical, neuroimaging, and neurophysiological investigations. Substantial progress has been made in the methods of presurgical assessment, particularly in patients with normal features on MRI, but evidence is scarce for the indication and effect of most presurgical investigations, with no biomarker precisely delineating the epileptogenic zone. A priority for the development of epilepsy surgery is the generation of high-level evidence to promote the harmonisation and dissemination of best practices.Copyright © 2014 Elsevier Ltd. All rights reserved.

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