Operating in the Dark … to See is to Cure

Abstract

Characteristics and Surgical Outcomes of Patients with Refractory Magnetic Resonance Imaging-Negative Epilepsies. Bien CG, Szinay M, Wagner J, Clusmann H, Becker AJ, Urbach H. Arch Neurol 2009;66(12):1491–1499. Objective: To explore several characteristics of patients with pharmacoresistant epilepsy without distinct lesions on magnetic resonance images (MRI-), who account for a relevant proportion of presurgical patient cohorts. Design: Retrospective case series. Setting: University epilepsy center. Patients: A cohort of 1200 patients who had comprehensive presurgical assessment from January 1, 2000, through December 31, 2006. Main Outcome Measures Frequency of MRI- patients in the total presurgical cohort, seizure-free outcome rates in patients who had surgery and those who did not, outcome predictors, and spatial properties of epileptogenic areas in MRI- patients with epilepsy. All MRI- patients were retrospectively analyzed. Presurgical MRIs were reevaluated for subtle cortical dysplasias by postprocessing and visual reassessment. Results: One-hundred ninety MRI- patients were identified (16% of all presurgical candidates); 29 (15%) had surgery. Eleven (38%) became seizure free (including those with auras only; 45%). Surgical therapy was more frequently offered to MRI+ patients (76%; P