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Outpatient ambulatory EEG as an option for epilepsy surgery evaluation instead of inpatient EEG telemetry.

Rizvi SA, Téllez Zenteno JF, Crawford SL, Wu A - Epilepsy Behav Case Rep (2013)

Bottom Line: Magnetic resonance imaging showed right mesial temporal sclerosis as well as an area of encephalomalacia at the medial inferior right temporal lobe.The patient has been seizure-free for 10 months after the surgery.The patient is preparing to go back to work, and his driver's license was reinstated 9 months postsurgery.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

ABSTRACT
Outpatient ambulatory EEG is more cost-effective than inpatient EEG telemetry and may provide adequate seizure localization in a presurgical evaluation. A 51-year-old right-handed male had been unable to work or drive since the age of 35 due to intractable partial onset epilepsy. A 72-hour outpatient ambulatory EEG recorded 18 seizures from the right temporal region. No epileptiform activity was seen in the left hemisphere. Magnetic resonance imaging showed right mesial temporal sclerosis as well as an area of encephalomalacia at the medial inferior right temporal lobe. Neuropsychological assessment found that the patient was a good neurosurgery candidate. At this point, the patient was considered to be a candidate for a right temporal lobectomy. A standard right temporal lobectomy was performed. The patient has been seizure-free for 10 months after the surgery. Follow-up EEGs show no epileptiform activity. The patient is preparing to go back to work, and his driver's license was reinstated 9 months postsurgery. Neuropsychological reassessment is pending, but no apparent change in cognition has been noticed by the patient or his family. Cases with a high congruence between diagnostic imaging and the EEG abnormalities identified in the portable EEG may provide enough information regarding seizure frequency and localization to eliminate the need for inpatient EEG telemetry in the evaluation of patients for epilepsy surgery. We believe that the use of aEEG in preoperative planning should be restricted to cases of TLE and to patients with a high frequency of seizures.

No MeSH data available.


Related in: MedlinePlus

One of the 18 seizures recorded with the aEEG. The seizure is characterized by rhythmic sharp theta mixed with spikes over the electrodes F8–T4 with spread to Fp2 and T6. The seizure finishes with sharp waves at F8 and T4 and delta. All the seizures were similar.
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f0005: One of the 18 seizures recorded with the aEEG. The seizure is characterized by rhythmic sharp theta mixed with spikes over the electrodes F8–T4 with spread to Fp2 and T6. The seizure finishes with sharp waves at F8 and T4 and delta. All the seizures were similar.

Mentions: The aEEGs were recorded using 24 AC channels with 4 differential and 4 auxiliary DC channels capable of continuous recording (XLTEK Trex Ambulatory System). Gold-plated cup EEG electrodes with a 10-mm diameter and a 2-mm center hole were attached to the scalp with collodion, according to the International 10–20 System. The 72-hour outpatient aEEG recording identified 18 electrographic seizure events originating from the right temporal focus (Fig. 1). Seizure onset was characterized by rhythmic theta activity mixed with spikes at the electrodes T4–F8 with spread to T6, followed by 4- to 5-Hz spike-and-wave discharge activity in the same region. The total duration ranged from 20 to 70 s. Right temporal theta and delta slowing was observed in the postictal phase. Interictal spikes were also present in the right temporal region, with the maximum at T4. No epileptiform activity was evident in the left hemisphere.


Outpatient ambulatory EEG as an option for epilepsy surgery evaluation instead of inpatient EEG telemetry.

Rizvi SA, Téllez Zenteno JF, Crawford SL, Wu A - Epilepsy Behav Case Rep (2013)

One of the 18 seizures recorded with the aEEG. The seizure is characterized by rhythmic sharp theta mixed with spikes over the electrodes F8–T4 with spread to Fp2 and T6. The seizure finishes with sharp waves at F8 and T4 and delta. All the seizures were similar.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150632&req=5

f0005: One of the 18 seizures recorded with the aEEG. The seizure is characterized by rhythmic sharp theta mixed with spikes over the electrodes F8–T4 with spread to Fp2 and T6. The seizure finishes with sharp waves at F8 and T4 and delta. All the seizures were similar.
Mentions: The aEEGs were recorded using 24 AC channels with 4 differential and 4 auxiliary DC channels capable of continuous recording (XLTEK Trex Ambulatory System). Gold-plated cup EEG electrodes with a 10-mm diameter and a 2-mm center hole were attached to the scalp with collodion, according to the International 10–20 System. The 72-hour outpatient aEEG recording identified 18 electrographic seizure events originating from the right temporal focus (Fig. 1). Seizure onset was characterized by rhythmic theta activity mixed with spikes at the electrodes T4–F8 with spread to T6, followed by 4- to 5-Hz spike-and-wave discharge activity in the same region. The total duration ranged from 20 to 70 s. Right temporal theta and delta slowing was observed in the postictal phase. Interictal spikes were also present in the right temporal region, with the maximum at T4. No epileptiform activity was evident in the left hemisphere.

Bottom Line: Magnetic resonance imaging showed right mesial temporal sclerosis as well as an area of encephalomalacia at the medial inferior right temporal lobe.The patient has been seizure-free for 10 months after the surgery.The patient is preparing to go back to work, and his driver's license was reinstated 9 months postsurgery.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

ABSTRACT
Outpatient ambulatory EEG is more cost-effective than inpatient EEG telemetry and may provide adequate seizure localization in a presurgical evaluation. A 51-year-old right-handed male had been unable to work or drive since the age of 35 due to intractable partial onset epilepsy. A 72-hour outpatient ambulatory EEG recorded 18 seizures from the right temporal region. No epileptiform activity was seen in the left hemisphere. Magnetic resonance imaging showed right mesial temporal sclerosis as well as an area of encephalomalacia at the medial inferior right temporal lobe. Neuropsychological assessment found that the patient was a good neurosurgery candidate. At this point, the patient was considered to be a candidate for a right temporal lobectomy. A standard right temporal lobectomy was performed. The patient has been seizure-free for 10 months after the surgery. Follow-up EEGs show no epileptiform activity. The patient is preparing to go back to work, and his driver's license was reinstated 9 months postsurgery. Neuropsychological reassessment is pending, but no apparent change in cognition has been noticed by the patient or his family. Cases with a high congruence between diagnostic imaging and the EEG abnormalities identified in the portable EEG may provide enough information regarding seizure frequency and localization to eliminate the need for inpatient EEG telemetry in the evaluation of patients for epilepsy surgery. We believe that the use of aEEG in preoperative planning should be restricted to cases of TLE and to patients with a high frequency of seizures.

No MeSH data available.


Related in: MedlinePlus