Abstracts

RATIONALE: Refractory TLE represents the most common epileptic syndrome ammenable to surgery. Prolonged video-EEG monitoring with multiple ictal recordings has been used as the gold-standard for focus localization in the pre-MRI era. After the introduction of MRI in the clinical practice, an increasing number of epileptic patients have been submitted to surgery based on imaging findings. This paper reports our results in the treatment of patients with refractory TLE in whom the surgical decision making did not include prolonged video-EEG monitoring. METHODS: One-hundred consecutive adult patients with refractory TLE were studied. In all, MRI showed unilateral MTS on visual inspection. All had complex partial seizures. Eighty-three percent of them had simple partial seizures. Sixty-six patients had unilateral interictal EEG abnormalities and 34 had bilateral independent temporal lobe spiking. All patients were submitted to a cortico-amygdalo-hippocampectomy under general anesthesia. Mean follow-up time is 18 months. RESULTS: Ninethy-one percent of the patients has been seizure-free since surgery. The other 9 patients are in Engel's class II. There was no surgical morbidity or mortality. CONCLUSIONS: The surgical results obtained in this series are similar to those obtained in patients with refractory TLE in whom video-EEG monitoring was included in the preoperative work-up. In this set of patients, preoperative prolonged video-EEG monitoring is not mandatory. The diagnosis of pseudo-seizures remains as the main indication for the use of prolonged monitoring in these patients. Home video recordings obtained by the family can also help in this regard.