When considering surgery for intractable partial seizures, evenwith high resolution MRI, some patients do not show structural abnormalities. The aim was to consider whether these patients werelikely to proceed to surgical treatment after scalp video-EEG telemetry. All patients undergoing presurgical evaluation at the National Hospital for Neurology and Neurosurgery between 1995and 1997 were reviewed and 40 were identified without definite MRIabnormalities. None of 40 disclosed a well localised epileptogenic zoneconcordant with other tests that would have allowed the patient toproceed directly to surgery. In five of the 40, evaluation led to ahypothesis that could be tested by intracranial studies; threeproceeded to surgery. It is suggested that high quality MRI isperformed first when surgical evaluation is undertaken and if negativethe patient carefully counselled before proceeding with anyinvestigations, as successful resective surgery is an unlikely outcomein such MRI negative cases.
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