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J Epilepsy Res. 2016 Dec 31;6(2):66-74. doi: 10.14581/jer.16013. eCollection 2016 Dec.

Change of Patient Selection Strategy and Improved Surgical Outcome in MRI-negative Neocortical Epilepsy.

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Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
Department of Neurology, Korea University College of Medicine, Seoul, Korea.



It is crucial to make selection strategy to identify surgical candidates among medically refractory MRI-negative neocortical epilepsy patients. In our previous study, we suggested two or more concordance between noninvasive studies (EEG, ictal scalp EEG, interictal FDG-PET, and SPECT) as a new patient selection strategy for MRI-negative neocortical epilepsy surgery. The objective of this study was to evaluate the surgical outcomes of MRI-negative neocortical epilepsy patients before and after the implementation of a new selection strategy.


From 1995 to 2011, we included 153 consecutive MRI-negative neocortical epilepsy patients who received focal resection and had a follow-up period of at least 2 years. These patients were divided into two groups according to their date of surgery (before and after July 2002). The old group consisted of 89 patients and the new one consisted of 53 patients. Clinical characteristics, presurgical evaluations, and pathology were reviewed.


The new patient selection strategy led to a significant increase in the concordance between two or more modalities. The improvement in surgical outcome after 2002 was significant (seizure-free outcome, 47.2% vs. 75.5%; p = 0.001). Concordance between two or more presurgical evaluations and localizing PET were related to a seizure-free outcome in a multivariate analysis.


After a change in surgical strategy to select patients with two or more concordance between noninvasive studies, the seizure-free outcome improved up to 75.5%. MRI-negative neocortical epilepsy patients with two or more concordance between noninvasive studies seem to be good candidates for epilepsy surgery.


Epilepsy surgery; MRI-negative neocortical epilepsy; Presurgical evaluation; Surgical outcome

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