Goals, methodology:Epilepsy surgery is defined as any neurosurgical intervention with the primary goal to relieve intractable epilepsy. On the other hand essential brain regions like primary motor and sensory cortex as well as brain areas supporting language and memory functions have to be spared to avoid neurological deficits caused by the operation. Thus, the exact localization of the epileptogenic zone and of essential brain regions is crucial for the successful surgical treatment of seizures that can only be accomplished during a thorough presurgical work-up. A new noninvasive brain mapping procedure magnetoencephalography (MEG) was employed during the presurgical evaluation for localization of the epileptogenic zones and for the determination of hemispheric dominance and intrahemispheric localization of linguistic functions in patients with drug-resistant focal epilepsies.Results: The role of MEG for the localization of the epileptogenic zone in the noninvasive evaluation of patients with focal drug-resistant epilepsies:We evaluated the sensitivity and selectivity of interictal MEG versus prolonged ictal and interictal scalp video-EEG in order to identify patient groups that would benefit from preoperative MEG testing. One hundred thirteen consecutive patients with medically refractory epilepsy who underwent surgery were included. The epileptogenic region predicted by interictal and ictal Video-EEG (V-EEG) and MEG was defined in relation to the resected area as perfectly overlapping with the resected area, partially overlapping, or nonoverlapping. Using MEG, we were able to localize the resected region in a greater proportion of patients (72.3%) than with noninvasive V-EEG (40%). MEG contributed to the localization of the resected region in 58.8% of the patients with a nonlocalizing V-EEG study and 72.8% of the patients for whom V-EEG only partially identified the resected zone. Overall, MEG and V-EEG results were equivalent in 32.3% of the cases, and additional localization information was obtained using MEG in 40% of the patients. MEG was most useful for presurgical planning in patients who had either partially or nonlocalizing V-EEG results.Functional organization of interictal spike complex in medial temporal lobe epilepsies:Thirty patients with mesial temporal lobe epilepsy (MTLE) using combined MEG and EEG recordings were icluded. Spikes could be recorded in 14 patients (47%) during the 2-to 3-h MEG/EEG recording session. The MEG and EEG spikes were subjected to separate dipole analyses and the spike dipole localizations were superimposed on MRI scans. All spike dipoles could be localized to the temporal lobe with a clear preponderance in the medial region. Based on dipole orientations in MEG, patients could be classified into two groups: patients with anterior medial vertical (AMV) dipoles, suggesting epileptic activity in the mediobasal temporal lobe and patients with anterior medial horizontal (AMH) dipoles, indicating involvement of the temporal pole and the anterior parts of the lateral temporal ...