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Epilepsy surgery evaluation — SCE Neurology MCQ

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HardEpilepsyEpilepsy surgery evaluationSCE Neurology

A 36-year-old woman has focal impaired-awareness seizures every month despite maximally tolerated levetiracetam and lamotrigine. MRI shows left hippocampal sclerosis and prolonged video-EEG records concordant left temporal ictal onset. Neuropsychology shows mild verbal memory impairment. She is otherwise fit. What is the most appropriate management?

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Correct answer: D — Refer to an epilepsy surgery programme

Refer to an epilepsy surgery programme is the best answer. Drug-resistant focal epilepsy with concordant temporal MRI and EEG should prompt referral to a specialist epilepsy surgery programme. A third drug has lower chance of seizure freedom than surgical assessment; vagus stimulation is usually palliative; routine EEG adds little after video-EEG; rescue medication alone does not address refractory epilepsy. Clinical pearl: Surgical referral is an assessment pathway, not a commitment to resection.

Reference: NICE NG217; ILAE epilepsy surgery referral recommendations