Drug-Resistant Temporal Lobe Epilepsy — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersDrug-Resistant Temporal Lobe EpilepsySCE Neurology

A 60-year-old man with a 3-year history of drug-resistant focal epilepsy is being evaluated for epilepsy surgery. MRI shows right hippocampal sclerosis. Video-EEG telemetry captures seizures with right temporal onset. What additional investigation is most important before proceeding to surgery?

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Correct answer: D — Neuropsychological assessment

Neuropsychological assessment is essential before temporal lobe epilepsy surgery to establish baseline cognitive function, lateralise language and memory, and predict the risk of postoperative cognitive decline. This is mandatory in the pre-surgical workup. A: Serum prolactin may help differentiate epileptic from non-epileptic seizures but is not part of surgical evaluation. C: A repeat MRI is not required if the lesion is already identified. D: Lumbar puncture has no role in epilepsy surgery workup. E: SCN1A mutations are associated with Dravet syndrome, not mesial temporal sclerosis.

Reference: NICE NG217 (2025); ILAE Commission on Neurosurgery (2019)