Abstracts

Rationale: Amygdala plays a central role in the pathogeny and semiology of temporal lobe epilepsy (TLE). Pure amygdalar injuries can induce epilepsy without damage of the rest of medial temporal lobe structures. It is well known that amygdala has prominent connections with structures around, then it is an opened question if in cases with amygdalar epilepsy (AE) a circumscribed steraotactic transsylvian selective amygdalectomy might suffice an might be a valid treatment option in patients with TLE, establishing amygdala as a limbic target in those selected cases. The aim of this study is to descrive different characteristics and surgery outcome , in our experience, in patients with epilepsy secondary to pure amygdalar epilepsy compared with epilepsy secondary to unilateral mesial temporal sclerosis (MTE). Methods: We compared clinical, electrical and neuropsychological characteristics (before and after surgery); of 4 patients with AE with regard to 7 patients with MTE treated with surgery and seizure free after 1 year follow up. All surgically treated patients underwent a prolonged video-EEG monitoring with seizure registration. Results: 11 patients with mean age of 46.5 (SD12.69), age at epilepsy onset 18.82 (SD15.64), seizure frequency (month) 7.55 (SD17.48), referred initial precipitating injury 0/4 (0%) AE compared with 6/7 (85%) MTE (p:0.05), psychic aura in 3/4 (75%) AE vs 2/7 (28%) MTE, nocturnal seizures 2/4 (50%) AE vs 1/7 (14%) MTE, normal intercritic EEG in 3/4 (75%) AE vs 0/7 (0%) MTE (p:0.029), not pre-surgery memory impairment in (75%) AE vs 0/7 (0%) MTE (p:0.029), post-surgery stable memory 2/2 AE vs 3/7 MTE . Conclusions: Patients with AE refer less initial precipitating injury, usually have psychic aura, their intercritic EEG could be normal and they present less memory impairment with regard to MTE patients. In AE patients selective amygdalectomy is effective and does not produce memory impairment.