Table of Contents
Epilepsy Research and Treatment
Volume 2012, Article ID 706917, 16 pages
Review Article

Determining Surgical Candidacy in Temporal Lobe Epilepsy

1Department of Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada M5G 1L5
2University Health Network, Toronto, ON, Canada M5G 1L5
3Division of Fundamental Neurobiology, Toronto Western Research Institute, Toronto Western Hospital, 4W-436, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8

Received 26 July 2011; Revised 26 October 2011; Accepted 3 December 2011

Academic Editor: Seyed M. Mirsattari

Copyright © 2012 Alireza Mansouri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Temporal lobe epilepsy (TLE) is the most common form of adult epilepsy that is amenable to surgical treatment. In the carefully selected patient, excellent seizure outcome can be achieved with minimal or no side effects from surgery. This may result in improved psychosocial functioning, achieving higher education, and maintaining or gaining employment. The objective of this paper is to discuss the surgical selection process of a patient with TLE. We define what constitutes a patient that has medically refractory TLE, describe the typical history and physical examination, and distinguish between mesial TLE and neocortical TLE. We then review the role of routine (ambulatory/sleep-deprived electroencephalography (EEG), video EEG, magnetic resonance imaging (MRI), neuropsychological testing, and Wada testing) and ancillary preoperative testing (positron emission tomography, single-photon emission computed tomography (SPECT), subtraction ictal SPECT correlated to MRI (SISCOM), magnetoencephalography, magnetic resonance spectroscopy, and functional MRI) in selecting surgical candidates. We describe the surgical options for resective epilepsy surgery in TLE and its commonly associated risks while highlighting some of the controversies. Lastly, we present teaching cases to illustrate the presurgical workup of patients with medically refractory TLE.