Modern brain imaging has led to a major reappraisal of the place of neurophysiology in pre-surgical assessment, certainly as far as resective procedures are concerned. An interictal record, even using semi-invasive electrodes and drug activation, can often be clearly focal but, if it is not, there can still be a surgically remediable lesion. Invasive neurophysiology is clearly indicated when there is a lack of concordance between investigations or observations in Phase 1 and when there is a discrepancy between the interictal neurophysiological findings and the suspected seizure origin. Seizures originating from the mesial surface of the cerebral cortex may be difficult to detect by simple scalp telemetry and, therefore, a negative result does not necessarily exclude surgery. In certain patients, who may be candidates for functional procedures, the interictal EEG may be an important selection criterion, as with bilateral synchronous spike wave discharges for callosotomy and "electrical status epilepticus of slow sleep" (ESESS) in Landau-Kleffner syndrome. With temporal lobe epilepsy, non-invasive tests make selection for surgery accurate and effective but outside the temporal lobe, invasive neurophys-iology plays a more important role, both in recording seizures and in allowing stimulation of the cerebral cortex to determine seizure origin and to locate eloquent areas. Major intracranial neurophysiological investigations are more hazardous and, therefore, these are placed in Phase 2.

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Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

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