IS REALLY NECESSARY TO PERFORM A VIDEO-EEG IN THE PREOPERATIVE EVALUATION OF MTLE-HS PATIENTS?

CONSALVO DAMIAN; AGUIRRE FLORENCIA; ODDO SILVIA; CENTURION ESTELA; PAPAYANNIS CRISTINA; SOLIS PATRICIA; KAUFFMAN MARCELO; KOCHEN SILVIA

Seattle. USA.

Congreso; American Epilepsy Society. Annual Meeting; 2008

Content:RATIONALE:For refractory patients with Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis (MTLE-HS) the first option of treatment is surgery. This will be successful if the preoperative noninvasive data shown unequivocal evidence of unilateral disease. The aim of this study was to define why patients with MTS-HS did not undergo surgery after a detailed non-invasive evaluation. METHODS:We selected 63 patients with MTLE-HS who were referred to our epilepsy program, with the indication of surgical treatment for the epilepsy from 2003 to 2007. The non-invasive evaluation comprise: a clinical interview, Video-EEG, high resolution MRI, neuropsychological testing and psychiatric interview. For those patients in whom the non-invasive evaluation methods were discordant they were classified into 3 groups: 1: Independent and bilateral ictal onset on scalp EEG; 2: Patients without chances to define clearly the side of the ictal onset on EEG; 3: Ictal onset EEG discordant with the side of HS on MRI. RESULTS:After the evaluation, 40 patients (63.5%) underwent surgery. Of the remaining 23 patients 2 were excluded because they needed psychiatric treatment before surgery and 3 patients refused the procedure. We analyzed 18 patients that were not operated, 11 female. Average age: 36 years (range 18-59). Group 1: 4 patients, 3 with left HS and 1 bilateral HS; Group 2: 8 patients, 6 left HS and 2 bilateral HS; Group 3: 6 patients, 3 left HS, 1 bilateral HS and 2 with dual pathology. There was no evidence of statistically significant differences between the groups. CONCLUSIONS:Our results support the need to conduct a detailed and careful evaluation before surgery for MTLE-HS patients, including a Video-EEG, for an appropriate selection of candidates for epilepsy surgery, particularly in patients with left HS.