G Epilepsy surgery
Surgery is recommended for patients with epilepsy when seizure control is intractable to conventional medical treatment. The goal of epilepsy surgery is to remove a focal area of epileptogenesis without causing neurologic deficits. Epilepsy surgery consists of two types: intracranial electrode placement and surgical resection. Intracranial electrode placement and testing may be required to localize epileptogenic foci. After localization, surgical resection may be performed. Extensive testing is required to define the focal area and its physiologic activity.
2. Preoperative assessment and patient preparation
a) History and physical examination are required.
(1) Neurologic: The patient should be assessed for history of uncontrollable focal or generalized seizures. Note the date of the last seizure. Obtain a description of seizure and prodromal symptoms. Obtain list of antiepileptic drugs. A Wada test (intracarotid injection of a barbiturate) may be performed to determine the dominance or speech function in the area of the surgery. A list of medications should be reviewed and the time of last antiepileptic drug noted.
b) Diagnostic tests
(1) CBC: A low hematocrit can be found in patients taking phenytoin or phenobarbital. A low white blood cell count can be found in patients taking carbamazepine or primidone. A low platelet count can be found in patients taking carbamazepine, valproate, ethosuximide, or primidone.
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