Is inpatient ictal video-electroencephalographic monitoring mandatory in mesial temporal lobe epilepsy with unilateral hippocampal sclerosis? A prospective study

Author(s)

Alvim, Marina K. M. ^[1] ; Morita, Marcia E. ^[1] ; Yasuda, Clarissa L. ^[1] ; Damasceno, Benito P. ^[1] ; Lopes, Tatila M. ^[1] ; Coan, Ana Carolina ^[1] ; Ghizoni, Enrico ^[1] ; Tedeschi, Helder ^[1] ; Cendes, Fernando ^[1]

Affiliation

^[1] Univ Estadual Campinas, Neuroimaging Lab, Dept Neurol, Campinas, SP - Brazil

• Document type: Journal article
• Source: Epilepsia; v. 59, n. 2, p. 410-419, FEB 2018.
• Web of Science Citations: 6

Abstract

ObjectiveTo compare surgical outcome in mesial temporal lobe epilepsy (MTLE) patients with unilateral hippocampal sclerosis (MTLE-HS) who had or did not have preoperative video-electroencephalographic monitoring (VEEG). MethodsA prospective study was undertaken with 166 consecutive pharmacoresistant unilateral MTLE-HS patients. All patients were investigated with detailed seizure semiology, serial routine outpatient EEG, magnetic resonance imaging, neuropsychological evaluation, and if necessary, other examinations. Postoperative follow-up ranged between 2 and 16years. Patients were divided into: (1) patients operated on based on routine outpatient EEG information, with >80% of EEGs with unilateral interictal epileptiform discharges (IEDs) ipsilateral to HS or ictal events (n=71); and (2) patients submitted to preoperative VEEG (n=95). To avoid the bias generated by ictal recordings, we performed a subanalysis of: (1) patients without preoperatively ictal recordings (n=80) and (2) patients with ictal recordings in VEEG or routine outpatient EEG (n=86). ResultsGroups were similar regarding gender, age at surgery, seizure onset, preoperative seizure frequency, and duration of follow-up. Overall, 136/166 (81.92%) were classified as Engel I seizure outcome, with no difference between groups; 76.84% and 88.73% of patients with and without VEEG, respectively, had Engel I postoperative seizure outcome (P=.77). The time lag until surgery was shorter in the group without VEEG (80 vs 38months; P=.01). Considering ictal recordings, 76.74% of patients with seizures recorded and 87.50% without ictal recordings had Engel I outcome (P=.11). SignificanceWe performed the first prospective study in a tertiary epilepsy center comparing surgical outcomes in unilateral MTLE-HS patients investigated preoperatively with and without VEEG. Based on the surgical outcome, VEEG is not imperative in patients with unilateral MTLE-HS who have compatible semiology and clearly ipsilateralized IEDs evaluated by a multidisciplinary and experienced epilepsy group. (AU)

• FAPESP's process: 12/05364-8 - Language assessment in temporal lobe epilepsy: correlations with structural and functional neuroimage.
• Grantee: Tátila Martins Lopes
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 15/17066-0 - Relationship between inflammatory markers and hippocampal and extra-hippocampal atrophy patterns in patients with temporal lobe epilepsy
• Grantee: Marina Koutsodontis Machado Alvim
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)