eprintid: 10193171 rev_number: 9 eprint_status: archive userid: 699 dir: disk0/10/19/31/71 datestamp: 2024-06-10 11:27:20 lastmod: 2024-06-10 11:27:20 status_changed: 2024-06-10 11:27:20 type: article metadata_visibility: show sword_depositor: 699 creators_name: Duncan, John S creators_name: Beech, Virginia creators_name: Chowdhury, Fahmida Amin creators_name: Miserocchi, Anna creators_name: McEvoy, Andrew title: Complicated epilepsy surgery: importance of balancing benefit and deficit ispublished: inpress divisions: UCL divisions: B02 divisions: C07 divisions: D07 divisions: F81 note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. abstract: The risk-benefit ratio of epilepsy surgery needs careful consideration, is different for each individual and requires a careful, informed dialogue between the person concerned and their medical advisers. We illustrate this process with Virginia, who has had refractory focal epilepsy from age 1 year and a left hemiparesis. At the age of 45 years, we discussed the possibility of epilepsy surgery and went through non-invasive investigations with structural and functional MRI, tractography, scalp video-EEG telemetry, neuropsychological and neuropsychiatric evaluations. This was followed by a decision to carry out intracranial EEG to define the area of seizure onset and its relation to an area of focal cortical dysplasia, eloquent cortex and tracts. We agreed to carry out a focal resection in the knowledge that this would result in a loss of left-hand function. One year later, Virginia is seizure-free on reduced medication. We describe the steps in the process with Virginia's views. date: 2024-05-31 date_type: published publisher: BMJ Publishing Group official_url: http://dx.doi.org/10.1136/pn-2023-003901 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2282975 doi: 10.1136/pn-2023-003901 medium: Print-Electronic pii: pn-2023-003901 lyricists_name: Duncan, John lyricists_name: McEvoy, Andrew lyricists_id: JSDUN52 lyricists_id: AWMCE45 actors_name: Duncan, John actors_id: JSDUN52 actors_role: owner full_text_status: public publication: Practical Neurology event_location: England citation: Duncan, John S; Beech, Virginia; Chowdhury, Fahmida Amin; Miserocchi, Anna; McEvoy, Andrew; (2024) Complicated epilepsy surgery: importance of balancing benefit and deficit. Practical Neurology 10.1136/pn-2023-003901 <https://doi.org/10.1136/pn-2023-003901>. (In press). Green open access document_url: https://discovery-pp.ucl.ac.uk/id/eprint/10193171/3/Duncan_Complicated%20epilepsy%20surgery_AAM.pdf