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Sammanfattning

In almost one third of patients with epilepsy, the seizures cannot be controlled with anticonvulsant treatment alone. The reason for this intractability may be found in pathological changes in the brain tissue at the molecular level. These patients can be identified due to their negative response to the first few trials of medical treatment. If a medically intractable condition is suspected, an MRI with a surgical protocol should be performed. If a structural lesion, including mesial temporal sclerosis, is diagnosed, the patient should be referred to a epilepsy surgery center. If curative surgery is not possible, a palliative surgical treatment should be considered. Temporal lobe surgery leaves two thirds of the patients seizure-free and reduces the mortality rate but does not necessarily improve their psychosocial status. The reason for the disappointing psychosocial outcome is most likely the long delay between the onset of the medically intractable condition and the operation.

MeSH