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Epilepsy: Neocortical

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Stereotactic and Functional Neurosurgery

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Abstract

Neocortical epilepsy can be a diagnostic challenge and its surgical treatments vary. However, while epilepsy arising from neocortical foci may have distinct presentation and management from the established canon of medial temporal lobe epilepsy, the overlap is not insignificant. The general principles for work-up and treatment of drug-resistant epilepsy hold true: a seizure disorder with a discernable, targetable focus should ideally be clinically recognized, the anatomic origin of seizures should then be reliably localized, and the surrounding indispensable cortex that limits extent of resection must be carefully delineated.

This chapter reviews resective surgery for medically intractable seizure disorders arising from the neocortex of temporal, frontal, occipital, and parietal lobes. While many of these epileptic syndromes do not strictly respect the anatomical borders of lobes, such an organization is helpful from a surgical standpoint, and the semantics of lobular categorization of epilepsy are widely used in the literature. Techniques of surgical resection particular to the lobe or syndrome of interest are reviewed, with a summary of outcomes related to each form of neocortical epilepsy described. With accumulating reports of acceptable rates of seizure control, neocortical epilepsy resections are becoming a more prominent tool in the arsenal of epilepsy treatment. Development of surgical expertise in these areas is necessary to offer a full range of treatment options to patients with medically refractory disease.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA

    Edward F. Chang

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  1. John P. Andrews
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  2. Edward F. Chang
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  1. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Nader Pouratian

  2. Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA

    Sameer A. Sheth

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Andrews, J.P., Chang, E.F. (2020). Epilepsy: Neocortical. In: Pouratian, N., Sheth, S. (eds) Stereotactic and Functional Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-34906-6_25

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