Abstracts

RATIONALE: Seizures are not an uncommon occurrence after an electrical injury. Development of intractable partial epilepsy after this insult has not been reported in the literature. We report our experience with two patients undergoing presurgical evaluation who developed intractable epilepsy shortly after this insult, without other identifiable risk factors. METHODS: A retrospective review of patients evaluated in the Epilepsy Surgery program at Henry Ford Hospital (1993-99) was performed to identify patients with a history of electrical injury. Selection required the electrical injury was considered a high voltage exposure, preceded onset of recurrent seizures, no other known risk factors present, and no MRI dysplastic lesion. Clinical semiology, EEG, MRI, ictal SPECT, MEG, neuropsychological and neuropathological data were reviewed. RESULTS: Two patients (ages 47, 38) were identified who were victim of an electrical injury (440V momentary shock, 120V 15 sec transmission) and developed seizures (latency, 1 and 12 months). MRI showed diffuse right temporal cortical/subcortical signal change in one and was normal in the other. Clinical semiology and EEG (interictal and ictal) suggested right temporal and independent bifrontal epileptic foci. Patient 1 underwent a right temporal resection after intracranial localization to mesial temporal structures. Patient 2 underwent both a VNS implantation and a trial of oxcarbazepine with minimal benefit. Neuropathologic findings of the resected tissue demonstrated significant focal neuronal drop out in the cornu ammonis and extensive formation of corpora amylacea. CONCLUSION: Intractable partial epilepsy secondary to electrical injury may result in diffuse cortical and subcortical injury and variable epileptogenic features. Voltage, vector of current transmission and length of insult may all be significant factors.