Drug-resistant epilepsy with negative MRI is frequently seen in patients considered for epilepsy surgery; however, clinical evaluation and surgical treatment is very complex and challenging. Advanced imaging techniques are needed to detect the location of the epileptogenic zone. In most cases, intracranial EEG recording is required to delineate the region of seizure onset - this carries some risks of major complications. Moreover, the borders between the recorded seizure onset and the location of important brain functions are often indistinct in MRI-negative epilepsy. Overall, the outcome of MRI-negative surgery is less favorable than that of MRI-positive surgery, but it can significantly improve with optimal management. Each chapter critically appraises the role and value of specific diagnostic and treatment techniques to address the challenges of MRI-negative epilepsy surgery. Authors critique evidence and share their expertise on the diagnostic options and surgical approaches that make epilepsy surgery possible and worthwhile in patients with this condition.
Elson L. So is Professor of Neurology, Epilepsy and EEG, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. Philippe Ryvlin is Head of the Department of Functional Neurology and Epileptology, Neurological Hospital, Hospices Civils de Lyon, Lyon, France.
Preface; 1. Scope and implications of MRI-negative refractory focal epilepsy Elson L. So and Philippe Ryvlin; 2. Seizure semiology and scalp EEG in MRI-negative refractory focal epilepsy Soheyl Noachtar and Elisabeth Hartl; 3. Clinical and advanced techniques for optimizing MRI in refractory focal epilepsy Neda Bernasconi and Andrea Bernasconi; 4. PET in MRI-negative refractory focal epilepsy Alexander Hammers; 5. Advanced SPECT image-processing in MRI-negative refractory focal epilepsy Elson L. So, Terence J. O'Brien and Benjamin H. Brinkmann; 6. MEG and magnetic source imaging in MRI-negative refractory focal epilepsy Koji Iida, Akira Hashizume and Hiroshi Otsubo; 7. Electric source imaging in MRI-negative refractory focal epilepsy Christoph M. Michel and Margitta Seeck; 8. Functional MRI in MRI-negative refractory focal epilepsy Friederike Moeller and Stephan Ulmer; 9. Multimodality image co-registration for MRI-negative epilepsy surgery Benjamin H. Brinkmann and Vlastimil Sulc; 10. Subdural electrode implantation and recording in MRI-negative epilepsy surgery Michael R. Sperling and Christopher T. Skidmore; 11. Depth electrode and stereoelectroencephalography in MRI-negative epilepsy Philippe Ryvlin, Alexandra Montavont, Karine Ostrowsky-Coste and Marc Guenot; 12. Ultraslow and high-frequency recordings in MRI-negative refractory focal epilepsy Vlastimil Sulc and Gregory A. Worrell; 13. Cortical mapping in MRI-negative epilepsy surgery Gonzalo Alarcon and Antonio Valentin; 14. Localization and surgery for MRI-negative temporal lobe and temporal-plus epilepsies Sang Kun Lee and Hyejin Moon; 15. Localization and surgery in MRI-negative frontal lobe epilepsies Chathurbhuj Rathore and Kurapath Radhakrishnan; 16. Localization and surgery in MRI-negative posterior cortical epilepsies Christoph Baumgartner and Susanne Pirker; 17. MRI-negative refractory focal epilepsy in childhood Prasanna Jayakar and Michael Duchowny; 18. Surgical approaches and techniques in MRI-negative focal epilepsy Sumeet Vadera and William Bingaman; 19. Histopathology findings in MRI-negative focal epilepsy Ingmar Blumcke and Roland Coras; 20. Neuropsychological issues in MRI-negative focal epilepsy surgery: evaluation and outcomes Rosana Esteller, Daniel L. Drane, Kimford J. Meador and David W. Loring; 21. Conclusion Philippe Ryvlin and Elson L. So; Index.