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Neurology India, Vol. 54, No. 2, April-June, 2006, pp. 151 Invited Comments Invited Comments Clusmann Hans Neurochirurgische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn Code Number: ni06043 Related articles: ni06041, ni06042 This is an interesting work on the histopathological spectrum in a large one center series of surgically treated patients with epilepsy. The paper provides a good and useful overview on the different typical findings. A number of representative and good quality illustrations provides additional orientation for readers with less experience with respect to typical epilepsy related pathology.[1] It should be stressed, that there is a considerable selection bias, when discussing different rates of findings in published studies. The bias can depend on e.g. presurgical selection criteria: if one includes a number of MRI-negative cases after undergoing extensive invasive EEG-monitoring, the rate of "normal" or "unclear" pathological findings will be higher. Thus, the spectrum depends also on presurgical evaluation and selection for surgery, which is not commented on in the paper.[2] However, more than half of the patients were younger than 18 years of age. This is interesting to note, especially because recent data demonstrate, that the overall benefit including neuropsychological performance and socio-economic aspects are superior in this age group.[3] Although not explicitly mentioned, the study is congruent to actual trends in epilepsy surgery. Modifications of surgical strategies are increasingly noticed to influence outcome after epilepsy surgery.[4] Thus, it would be interesting to know more about the work of this group, especially with respect to patient selection, evaluation protocol, surgical strategy, morbidity and outcome. References
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