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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

A coronal section shows clear atrophy of the right hippocampus with signal changes consistent with mesial temporal sclerosis.
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f0010: A coronal section shows clear atrophy of the right hippocampus with signal changes consistent with mesial temporal sclerosis.

Mentions: At the time of evaluation, the patient was taking lamotrigine (150 mg twice daily), valproic acid (500 mg three times per day), and carbamazepine (400 mg in the morning and 600 mg in the evening). Magnetic resonance imaging of the brain disclosed right mesial temporal sclerosis (Fig. 2) as well as an area of encephalomalacia at the medial inferior right temporal lobe. Neuropsychological assessment indicated that the patient was cognitively intact. Typically, vEEG monitoring documentation of seizure localization has been considered as one of the most important aspects of a presurgical investigation in refractory temporal lobe epilepsy (TLE). Patients are not routinely considered for surgical resection until inpatient vEEG telemetry is performed. In this case, however, the aEEG was strongly suggestive of a right medial temporal seizure focus. This observation was further supported by homologous clinical and neuroimaging data. The patient was thus considered to be an ideal candidate for a right temporal lobe resection, even in the absence of confirmatory inpatient vEEG telemetry.


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)

A coronal section shows clear atrophy of the right hippocampus with signal changes consistent with mesial temporal sclerosis.
© Copyright Policy
Related In: Results  -  Collection

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

f0010: A coronal section shows clear atrophy of the right hippocampus with signal changes consistent with mesial temporal sclerosis.
Mentions: At the time of evaluation, the patient was taking lamotrigine (150 mg twice daily), valproic acid (500 mg three times per day), and carbamazepine (400 mg in the morning and 600 mg in the evening). Magnetic resonance imaging of the brain disclosed right mesial temporal sclerosis (Fig. 2) as well as an area of encephalomalacia at the medial inferior right temporal lobe. Neuropsychological assessment indicated that the patient was cognitively intact. Typically, vEEG monitoring documentation of seizure localization has been considered as one of the most important aspects of a presurgical investigation in refractory temporal lobe epilepsy (TLE). Patients are not routinely considered for surgical resection until inpatient vEEG telemetry is performed. In this case, however, the aEEG was strongly suggestive of a right medial temporal seizure focus. This observation was further supported by homologous clinical and neuroimaging data. The patient was thus considered to be an ideal candidate for a right temporal lobe resection, even in the absence of confirmatory inpatient vEEG telemetry.

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