Abstracts

RATIONALE: Cortical dysplasias are frequently associated with severe partial epilepsy, particularly when the EEG shows continuous epileptiform discharges (CEDS) METHODS: We reviewed records (chart, EEG, MRI) of three patients with CEDS and/or subtle dysplasias on MRI who did not have intractable seizures. RESULTS: Case 1: 28 year old male with episodes of crying, small pupils and adversive posture at age two, presented with complaints of objects perceptually moving. He had been on no medicine for many years since childhood, and was currently a graduate student. Exam revealed a right inferior quadrantanopsia. EEG showed CED's from the left occipital area at 3 Hz to 6 Hz. MRI showed Slight thickening of gray matter in the left occipital pole. Carbamazepine was given without further complaints. Case 2: 27 y/o female who had a benzodiazepine withdrawal seizure at age 20, presented age 26 with two tonic-clonic seizures, following discontinuation of zolpidem and carisoprodol. She had never been treated with AED's. MRI was normal. EEG showed CED's at C3-P3 sometimes involving whole left posterior head region. No clinical correlates of these were observed on video-EEG. She has been treated with valproate and lamotrigine with poor compliance, but no clinical seizures. Case 3: 35 year old female who began having episodes of "fainting" and depression following birth of her first child which recurred after her third child. She began complaining of a wide variety of somatic and psychic sensations, and was treated with carbamazepine without relief. An outside EEG reported bifrontal sharp waves, but its review revealed no epileptiform transients. MRI showed a subtle thickening of a R frontal gyrus. Video-EEG for 10 days off all medications revealed only non-epileptiform seizures (slumping to floor, tremulousness, vertigo), and without EEG correlates. It was determined that she was depressed and abusing pain relievers. With counseling and antidepressants no further events have occurred. CONCLUSIONS: Neuronal migration disorders can be associated with intractable epilepsy but may also exist in subjects with non-intractable epilepsy or no seizures. Treatment should be based on the clinical and EEG findings, not on the MRI.