title: An audit of the presurgical evaluation and patient selection for extratemporal resective epilepsy surgery in a resource-poor country.
abstract: OBJECTIVE
  The selection of ideal candidates for extratemporal resective epilepsy surgery is a challenge in resource-poor countries because of the limited presurgical diagnostic facilities and their affordability. To audit the presurgical evaluation strategy and selection for extratemporal resective epilepsy surgery in a resource-poor region.
  
  
  METHODS
  From the prospective database maintained at an epilepsy surgery center in southern India, we reviewed the data of consecutive patients who underwent presurgical evaluation from January 2005 through December 2008 for antiepileptic drug-resistant focal epilepsies emanating from the frontal, parietal and occipital lobes. Out of 285 patients, only 71 (24.9%) underwent resective surgery; the remaining 214 (75.1%) patients could not be selected for surgery. We inquired the reasons for their exclusion from surgery.
  
  
  RESULTS
  The difference in the rates of seizure-free outcome between surgical and non-surgical groups was highly significant (73.2% vs. 7.7%, P<0.0005). The major reasons for exclusion from surgery were normal MRI in 107 (50%), inability to afford invasive EEG monitoring in 40 (18.7%) and lesion location adjacent to eloquent cortical areas in 27 (12.6%) patients. While clustering of seizures and presence of preoperative neurological deficits favored surgical selection, the presence of secondary generalized seizures and discordant interictal epileptiform abnormalities were associated with exclusion from surgery.
  
  
  CONCLUSIONS
  We conclude that, in a resource-poor country, ideal candidates for extratemporal resective epilepsy surgery are those with well-circumscribed lesions not adjoining eloquent cortical areas. In such patients, concordant EEG findings and absence of preoperative secondary generalized seizures reinforce selection for surgery.
authors.affiliation: R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Gopal Krishna
authors.initials: GK
authors.lastname: Dash
authors.forename: Ashalatha
authors.initials: A
authors.lastname: Radhakrishnan
authors.forename: Chandrasekharan
authors.initials: C
authors.lastname: Kesavadas
authors.forename: Mathew
authors.initials: M
authors.lastname: Abraham
authors.forename: P Sankara
authors.initials: PS
authors.lastname: Sarma
authors.forename: Kurupath
authors.initials: K
authors.lastname: Radhakrishnan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000191:economics; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D005260:Female; D006295:Health Resources / Q000191:economics; D006801:Humans; D007194:India; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D055815:Young Adult