Abstract

Although appropriate anti-epileptic medication control seizures in epilepsy patients, 1/3 of the patients are drug resistant. In this intractable patient group, surgical resection is the primarily preferred treatment option. In early childhood, patients tolerate surgery better and surgery significantly influences good neurological development. Therefore, every drug-resistant case should be promptly referred to the relevant center as a potential candidate for surgery and for detailed investigation and further treatment. Seizure type is classified with clinical status and video- electroencephalography monitoring (VEM); magnetic resonance (MR) imaging detects structural causes for epilepsy. If semiology, VEM and MR findings are discordant or there is no structural lesion on MRI, Nuclear Medicine techniques [single photon emission computerized tomography (SPECT) and positron emission tomography (PET)] play key roles in the investigation. SPECT and PET are important for lateralization/localization of the epileptogenic zone, therapy planning, guidance for subdural electrode placement, evaluation of epilepsy syndromes in childhood by showing abnormal brain regions and demonstrating the functional status of the brain in intractable epilepsy. Finally, all the findings of these procedures should be discussed in multidisciplinary team for better surgical approach or palliative procedures individually.